Payment FAQs

  • I am not an in-network provider with insurance. As an out-of-network provider, I do not bill insurance. Appointments are billed directly to you at the time of service.

    Most therapy services have procedure codes that are billable to insurance. For insurance billable services, I will provide an itemized receipt (i.e., Superbill) that will allow you to seek reimbursement with your insurance company for out-of-network benefits. It is your responsibility to make sure that your insurance company reimburses for speech-language pathology services.

    I cannot emphasize enough, the importance of contacting your insurance company to make sure that you will be reimbursed.

    • Caregiver training appointments (no client present) provided as part of a plan of care that includes direct services are also billable to insurance, but insurance reimbursement is inconsistent.

    • Parent coaching appointments provided without direct service to the client are not insurance billable.

    • Myofunctional therapy will only be insurance billable if it is associated with a feeding or communication disorder.

    • Does my plan offer out-of-network benefits for speech therapy? (see the next page for your procedure and diagnosis codes)

    • Is teletherapy a covered service?
      Will I have a co-pay or co-insurance?

    • Are benefits subject to a deductible? What is the out-of-network deductible? Is it separate from our in-network deductible? How much of our out-of-network deductible have we met so far this year?

    • Once met, what is the usual and customary reimbursement amount (the allowable) for the procedure being billed? Your insurance company will only pay towards their allowed amount which may be less than the billed amount.

    • Is there a yearly benefits limit?

    • Is this benefit combined with other therapy services (e.g. occupational therapy, chiropractic, physical therapy)?

    • Are there policy exclusions for speech therapy benefits? Be aware that plans may exclude specific diagnosis codes such as developmental codes starting with an “F”, or may provide coverage only for injury, illness, or congenital anomalies).

    • Is preauthorization required for evaluation and/or speech therapy? If preauthorization is required, what is the process for getting it?

    • Is a physician referral required?

    • What is the time period between submission and reimbursement

    • What paperwork/information will I need to provide to my insurance company for reimbursement?

    • How and where do I submit claims?

  • Many services do qualify for use of HSA or FSA funds.

    Please check with your plan administrator to determine their requirements.

Glossary of Insurance-Related Terms

  • —an insurance benefit package which details services covered, deductible, copays, co-insurance, and plan limitations.

  • —a medical provider who has a contract with the insurance plan. Note: a provider may be contracted with an insurance company, but not in-network for every plan that company offers. 

    I am not in-network with any insurance company.

  • —a medical provider who is not contracted with the medical plan.

    I am out-of-network with all insurance companies

  • —the amount determined by the patient’s insurance plan that the patient must pay annually towards their medical care before insurance will contribute, including for reimbursement purposes.

    Most plans will have separate in-network and out of network deductibles. Some services may not be subject to the deductible.

    As an example, if an insurance plan has a $1,500 deductible, the patient will have to pay the full allowed amount for each visit until they have reached $1,500 at which point insurance will start to pay.

    Some people have no deductible. Some people have a $7,500 deductible. Knowing what how much you will have to pay before insurance begins contributing will help you know what to expect.

  • —a fixed rate assigned by the insurance plan that a patient will pay for each time services are rendered.

    For example, if your insurance company has an allowed amount of $100, they might choose to pay $80 for each session and hold you financially responsible for the other $20.

    This may be applicable to out-of-network services. You will want to ask about this during your call to your insurance company.

  • —the percentage of the allowed amount that insurance assigns as the patient’s responsibility. Most plans will have separate in-network and out of network coinsurance rates.

    For example, if a patient has a 20% coinsurance and the allowed amount for an office visit is $120, the insurance plan will pay $96 and the patient will be responsible to pay $24 (20% of $120=$24)

    This may be applicable to out-of-network services. You will want to ask about this during your call to your insurance company.