Is Speech Therapy Covered by Insurance?

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Realistically, parents do think about the cost of speech therapy.

As much as your late-talking children may need these services, it’s not advisable to pay directly from your pockets unless you have the cash to spare.

In fact, it may still not be practical then.

So, is speech therapy covered by insurance?

The good news is speech therapy insurance is available to those whose kids require speech therapy medically.

Today, we’ll discuss when speech therapy is medically necessary, how parents can avail of free services, and what the best age to start speech therapy is.

Is Speech Therapy Medically Necessary?

Speech therapy is considered to be a medical necessity for swallowing disorders and communication disabilities.

However, it is only considered medically necessary in other scenarios if the following set of criteria is met:

  • The doctor determines that the patient’s condition can improve immensely with speech therapy.
  • The improvement should occur within a reasonable and predictable time frame.
  • Seeks services performed by licensed and certified providers
  • Seeks services that are, by nature, to be performed by a licensed SLP or provided under the supervision of a licensed aide in accordance with state laws
  • Seeks therapy services that are in accordance with the care plan devised by the treating physician as permitted under applicable laws and policies
  • When an 18-month-old or older member experiences delays in speech and language development that are idiopathic. The member must have also been assessed by a qualified provider who determined that a treatable communication issue exists.
  • Home-based speech therapy, given that the member is homebound. This usually occurs when the member transitions from hospital care to home health care.

Does insurance cover speech therapy?

When the requirements are met, yes, speech therapy insurance can be used to offset direct-from-pocket payments.

When Is Speech Therapy NOT Medically Necessary?

Is speech therapy covered by health insurance?

In the following scenarios, you can’t count on it to be:

  • When the specific treatment the patient requires is already provided for by another service, like occupational or physical therapy.

In the administration of multiple treatments, there have to be separate treatment plans for each, which indicates the significant difference between procedures.

  • The medical necessity of speech therapy, according to most contracts, does not cover exercises, techniques, and drills that preserve present cognitive function and delay regression.

These are maintenance programs that usually start after therapeutic plans have achieved their desired goal.

  • When speech therapy is used to treat chronic cough
  • When the skills of a licensed speech language pathologist are not required for treatment.

These include treatments for maintaining function, such as routine and reinforced procedures. These tasks can usually be carried out by professional or family caregivers.

Does insurance cover speech therapy? Likely not in such situations.

As a result, you want to research other effective payment plans for scenarios where speech therapy is not a medical necessity.

is speech therapy covered by insurance

Speech Therapy for Kids That Are Not Covered by Insurance

Is speech therapy covered by health insurance?

We now know that it isn’t always the case.

Hence, you will have to find other methods to offset out-of-pocket therapy payments if your situation falls under the following:

  • Speech therapy needed to treat self-correcting dysfunctions, natural disfluency in youngsters, and self-correcting problems in articulation resulting from natural development
  • Educational training services for loved ones

Is Speech and Language Therapy Free?

Does health insurance cover speech therapy?

Instead of answering that, we’ll show you how to get speech therapy services completely free of charge.

If your little one suffers from speech issues that make them struggle in school, you naturally want to know where you can get therapy services (preferably for free).

Some public elementary schools offer free speech therapy programs.

However, if your child isn’t in elementary yet, do you have to wait until he or she reaches that age, or can you get free therapy services now?

Speech therapy can be free for some pre-schoolers.

Services like early intervention, which is applicable to infants and toddlers, and special services for kids under five who meet the criteria for special education are available.

In fact, it isn’t a requirement for your child to be in preschool.

He or she can be at home or in daycare and may still be able to receive these services.

Of course, not every child may qualify.

Each state has a different set of rules for who qualifies for speech therapy services.

However, in general, a child should be delayed developmentally to earn qualification.

Or, your child must be suffering from a disability that belongs to the 13 legal classifications.

What Is the Best Age to Start Speech Therapy?

While signs of developmental speech delays can surface as early as three months, at this point, there’s still a good chance he or she meets his next speech milestones on time.

So, while it’s good to talk to a therapist regarding your concerns, the professional might not require you to seek treatment for your child just yet.

They’d suggest early intervention and signs monitoring at home, yes.

But as for actual treatments, they may have to wait until communication issues persist well into the child’s first year.

If at 12 months, your child still doesn’t respond when being spoken to, you might want to consider seeing a specialist.

By the one-year mark, your child should already be using gestures to communicate what he or she wants.

This is an indication of your child’s understanding of communication and his or her possession of the basic skills required to communicate with you.

So, Is Speech Therapy Covered by Insurance?

Does health insurance cover speech therapy?

In scenarios where they are medically necessary, the answer is: yes.

However, there may be slight variations as to the coverage, depending on the state rules that govern qualification.

Generally, the “is speech therapy covered by insurance” question is not something you need to worry about when a child is developmentally delayed.

The same goes if the youngster has any disability that falls under the 13 legal categories.

In any of these situations, you may avail of free therapy services in your state.