We created these instructions to help you determine if your health insurance company will cover speech therapy for your child. If your child has secondary insurance, verify your benefits with both companies.
Step 1: Get Ready to Call
Print this document or if you prefer, you can fill it out on your computer. Either way, be sure to save it for future reference.
Have your child’s current insurance card on hand. If you don’t have it, the insurance company should be able to look up your policy with other personal information.
Call the number on the back of the insurance card. If you don’t have the card, use gethuman.com/phone-number to lookup the number.
Step 2: Make the Call
After dialing the number, your first goal is to reach an actual person. Once you are connected to a representative write down:
Current Date & Time: _________________________ Name of Representative: _________________________________
Next, tell the representative:
“I am calling to check on my benefits and coverage.”
“My child needs speech therapy. I would like to speak with someone who can answer my questions about my policy and the rules of coverage for speech therapy.”
Ask to speak to a supervisor if you feel the representative does not have the information you need.
Step 3: Ask These Questions about Coverage
“Under what circumstances does my policy cover speech therapy?”
“Does my policy have an exclusion clause about covering therapy, such as ‘therapy will only be covered if the deficit is due to accident, illness or injury’?” Yes / No
If yes, ask, “What is the clause?”
“How many visits are allowed per year, per therapy?” ___________________
Note: Sometimes Speech Therapy visits are grouped together with Occupational and Physical Therapy visits. If your child receives these services, clarify if the number of visits allowed is shared between all three therapies, or if there is a set number for each discipline.
# of Speech Visits:______ # of Occupational Therapy Visits:______ # of Physical Therapy Visits:______
“Have any visits been used to date?” Yes / No
“If yes, how many visits are left?”
# of Speech Visits:______ # of Occupational Therapy Visits:_____ # of Physical Therapy Visits:____
“Do I need any Pre-Authorization from child’s Primary Care Doctor for Speech Therapy
services?” Yes / No
If yes, “What do I need from the doctor?” (prescription, medical records, initial evaluation, letter of medical necessity)
“How many sessions are covered by each authorization?”____________
“What period of time will an authorization cover? (# of months, days, etc.)” ___________
“Once visits are used up, under what circumstances can my child get more visits authorized?”
Step 4: Ask These Questions About Co-pays, Co-Insurance, & Deductibles
“What are the dates of my child’s benefit plan?” ___________________ to ____________________
“What is the deductible?” _________________________
“When does the deductible start over?” _________________________
“How much of the deductible has been met?” $ _________________
“Do we have a co-pay for speech therapy visits?” Yes / No
If yes, “How much is the copay? Is this per day or per therapy visit?”
amount: $_________________ per: Day Visit
“Are we responsible to pay co-insurance for speech therapy visits?” Yes / No
If Yes, “How much is my co-insurance?” %_____________
“Do we need to meet the deductible before we begin to pay co-pays/co-insurance for Speech Therapy?” Yes / No
Step 5: Ask These Questions About Speech Therapy Providers
“Can we choose any certified speech therapist?” Yes No
“Can we choose a therapist outside of our network/provider list?” Yes No
If yes, “Is our coverage different outside of the network/provider list?”
Yes / No
If yes, “What is the difference in our coverage for an out-of-network provider vs.
Out-of-network v. In-Network
Deductible: $_______________ $_______________
Co-pay: $_______________ $_______________
Co-insurance: %_______________ %______________
Out of pocket max: $________________ $_______________
Number of visits: _________________ ________________