Insurance Coverage for Therapy

Before a first visit with our Speech-Language Pathology Program, we strongly encourage you to contact your insurance company directly to ask specifically what will be covered during your visit(s). If services are not covered by insurance, the hospital asks for payment on the day of the appointment.

Possible Insurance Plan Requirements

For example, your insurance plan may require any of the following:

  • A physician’s order for treatment
  • Pre-authorization before treatment can begin
  • A referral from your primary care provider
  • Limited number of annual visits
  • Limited dollar amount paid toward annual services

Possible Non-Coverage Reasons

The following is a list of reasons why insurance companies may not cover therapy services.

  • It’s maintenance therapy
  • It’s for development delay
  • It’s not medically necessary
  • It’s only covered for treatment that is restorative (i.e., if skills were lost because of illness, accident or injury)
  • Must result in significant improvement within a certain timeframe
  • You’ve used your plan’s entire benefit for the calendar year

Suggestions for Families

  • Act as the liaison between the insurance company and your child’s therapist or physician
  • Keep a log of insurance calls, including the names of the individuals you speak with
  • Keep copies of all letters from your insurance company
  • Ask to speak with our insurance coordinator