As private insurance companies seek new ways to lower their costs, many cut coverage for necessary developmental or rehabilitative speech-language therapy. These essential services often show up on the “exclusions to coverage” list.

With an estimated 8-16% of children in the United States affected by a speech-language disorder, these companies simply don’t want to pay the high cost of coverage.  Unfortunately, this leaves many families with few options. A typical out-of-pocket speech therapy session cost between $100-250 per hour. For many, that’s simply unsustainable.

Families may find that their plans exclude speech therapy coverage before even beginning the evaluation and treatment process. Others may receive their denial letter in the mail, four weeks after their child was evaluated by a speech-language pathologist.

Of course, there is a process to combat these denials. But therapists and families can often get caught in a loop of insurance appeals, more denials, peer-to-peer medical reviews - all to end up back at Point A with their patient or child still being underserved or denied services.

Why is insurance denying speech-language services

Reasons for denying or limiting coverage vary depending on the case. Insurance companies are required to provide a written response outlining their rationale. Here’s a few of their most common objections:

  • Treatment is ‘not medically necessary’
  • Speech-language therapy is not a covered service
  • Local public school provides services
  • Treatment is educational/developmental in nature

Research in speech and language intervention has demonstrated that the earlier the intervention, the better the outcomes. Families who have children in need of speech, language, feeding, or swallowing therapy shouldn’t have to go through all these insurance headaches. And paying out-of-pocket can be so costly that families might end up putting speech therapy on the back-burner for even longer.

Online teletherapy is one answer to this exasperating problem. Without the need for a brick-and-mortar clinic, speech-language pathologists are able to keep the cost of private pay sessions low. Clinicians and families can meet on their own schedules without needing to spend gas money on either end of the session. Cutting insurance out of the picture means no hoops to jump through, no appeals battles to fight, and no wasting valuable time in your child’s development.

If you’ve been dealing with insurance difficulties and are looking for an affordable solution to paying out-of-pocket, see how Expressable can help.

Sources:

https://www.asha.org/uploadedFiles/practice/reimbursement/private-plans/AppealingClaims2006.pdf

https://www.asha.org/uploadedFiles/public/add-benefits/HealthInsBrochure.pdf