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Navigating the Out-of-Network Speech Therapy Insurance Reimbursement Process

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Finding the right speech-language pathologist (SLP) and starting speech therapy is one challenge. Submitting an insurance claim can be a second daunting process. Here’s the good news - you are not alone. Many of our Speech SF families have successfully navigated the process of submitting insurance reimbursement claims for out-of-network speech therapy.

In this guide, we will walk you through the entire process of submitting an insurance claim for out-of-network speech therapy, including what service codes and diagnoses codes are common, and what files to submit. Please note we are not currently in-network with any insurance company. We recommend calling the number on the back of your insurance card to see exactly what they need.

The first step in submitting an insurance claim is to gather all the necessary documents. These documents include the name of the SLP, the dates of service, the diagnosis and service codes, along with the cost of each session. It is important to collect all diagnostic and treatment documents related to your child's speech threapy These documents should include the initial evaluation report, a treatment plan, and progress reports. If you are a Speech SF client, you can find all of these documents in your client portal. A quick checklist:

  • Invoices

  • Superbills

  • Initial evaluation report and any progress notes

Once you have gathered all the required documents, it's time to submit the insurance claim. When submitting a claim, you need to make sure you have the correct service codes (CPT) and diagnosis codes (ICD-10). These are found on your superbills from above.

Some common service codes (CPT) for speech therapy include:

  • 92521 (Evaluation of fluency)

  • 92522 (Evaluation of speech sound production)

  • 92523 (Evaluation of speech and language skills)

  • 92507 (Individual Treatment of Speech Sound Production, Language, or Fluency)

  • 92508 (Group speech therapy)

The correct diagnosis code (ICD-10) will depend on your child's specific diagnosis, but common codes include:

  • F80.0 (Articulation/Speech Sound Disorder)

  • F80.1 (Expressive Language Disorder)

  • F80.2 (Receptive and Expressive Language Disorder)

It's important to check with your insurance provider for any specific codes or additional information they require. After submitting the claim, it may take some time for your insurance provider to process and determine coverage. If the claim is approved, you will receive a reimbursement for a portion of the cost of each session. This amount may vary depending on your plan and out-of-network benefits.

Navigating the process of submitting an insurance claim for out-of-network speech therapy can be overwhelming, but having the right information, documentation, and the correct codes can make the process significantly easier. Remember to gather all the required documents, have the correct service codes and diagnoses codes, provide supporting documentation from the therapy sessions, and be ready to answer any questions. Out-of-network speech therapy can be more costly, and submitting a superbill can help offset some of these costs. With this guide, you're now empowered to navigate the process and get your child the speech therapy services they need.

Interested in starting speech therapy with us? Schedule a consult call here.


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