Abby Barnes, M.S., CCC-SLP
Health insurance can be a huge help for many types of medical expenses, including speech therapy. But does insurance cover the cost of speech therapy for stuttering? The answer can vary depending on your insurance coverage and your speech therapy needs.
Here’s what you need to know about insurance and speech therapy for stuttering, including what to do if your health plan doesn’t cover speech therapy.
How do you know if your insurance covers stuttering treatment?
If you or your child has a stutter and would like to have an evaluation with a speech therapist, the first thing to do is find out what your health plan covers. The American Speech-Language Hearing Association (ASHA) recommends reviewing your insurance policy and searching for terms such as “speech therapy,” “speech-language pathology,” “physical therapy and other rehabilitation services,” or “other medically necessary services or therapies.”
It’s also a good idea to call and talk with an insurance representative to ask if speech therapy is covered. When you call, even for a minor question, ask for the representative’s name. Write it down, as well as the date and time you spoke with them and what they told you. This is important in case you need to refer to these details later in the process of obtaining coverage for speech therapy.
Questions to ask your health insurance about speech therapy for stuttering
It’s important to get all the details about what your plan covers. Children's Hospital of Philadelphia recommends asking your insurance these questions:
Does my plan cover a speech-language evaluation for stuttering?
Do I need a referral for an evaluation?
Does my plan cover ongoing speech therapy for stuttering (ICD-10 F98.5)?
Before setting up speech therapy, do I need to:
Get a referral or script from my doctor?
Get pre-certification from my insurance company?
Choose a speech therapist from within my insurance network?
Do I have a maximum number of speech therapy visits per year?
Do I have to pay a deductible or a co-pay for speech therapy?
Do I need to schedule all of the speech therapy visits by a certain date?
Getting this information upfront can save you time and energy. Think about this scenario: Let’s say your insurance does cover speech therapy, but only a certain number of sessions. This is important information to know at the beginning! Make sure to ask about these details before you begin the speech therapy journey.
How a speech evaluation works for stuttering
Speech therapy for both children and adults begins with a speech-language evaluation. Many insurance plans will cover an initial evaluation from a speech-language pathologist, also known as a speech therapist. During the evaluation, the speech therapist will assess the person’s speech fluency, or smoothness of speech. The speech therapist will determine if speech therapy is needed and, if so, what the goals for therapy should be.
The speech therapist will then write up an evaluation report. This report discusses their findings, whether speech therapy is recommended, the frequency of therapy, and the therapy goals. The speech therapist will also likely provide information about the overall necessity for stuttering treatment. This is key information that your health plan will look at. The speech evaluation report is sent to your insurance company for review. They will then make a decision about coverage for speech therapy.
What to do if your insurance won’t cover speech therapy for stuttering
In some cases, insurance will cover a speech evaluation, but they won’t cover speech therapy based on the findings in the evaluation report. This is called a denial. You have the right to appeal the denial. Being persistent can pay off, so stick with the appeal process! If speech therapy for stuttering is denied, there are several things ASHA recommends you do to try to appeal. First, ask the insurance company to provide the reason therapy was denied in writing. Then, try these steps:
1 Write a letter to your insurance to state why you’re appealing their denial
Make sure you address the things your health plan has decided are unnecessary to cover. For example, let’s say you’re trying to get speech therapy coverage for your child’s stuttering. But insurance has deemed speech therapy as medically unnecessary. You can state that the clarity of your child’s speech is a medical necessity for their safety. If your child is in an emergency situation and can’t clearly communicate what they need, what happened, or information about themselves (such as their name or phone number), this is unsafe and puts your child at risk.
You know the most about your child's speech and their ability to communicate. Be confident and persistent!
As your child’s caregiver, you know the most about their speech and their ability to communicate. Be confident in what you know when making the case for speech therapy!
2 Talk with your child’s doctor
When appealing a denial for speech therapy coverage, you may need to provide a letter of referral from your child’s doctor. Your doctor can speak to the medical necessity of stuttering treatment for your child. Talk with your child’s pediatrician about your appeal and how they can help.
3 Involve the speech therapist who did your evaluation
Include your speech therapist in the appeal process, as well. ASHA has a letter that speech therapists can send to insurance companies to advocate for their clients who stutter. It explains why speech therapy services are medically necessary to treat a stuttering disorder in children and adults. Your speech therapist can also include specific information about you or your child that they think would help your appeal.
Other ways to access speech therapy for stuttering
For some people, speech therapy is only possible if insurance is reimbursing the cost. But for others, additional options may work if insurance won’t cover speech therapy. Let’s take a look at some of them. Use your HSA or FSA. If you have a health savings account (HSA) or flexible spending account (FSA), they will likely reimburse for speech therapy services. This is something to ask your insurance company about. Consider out-of-pocket payment. This is sometimes called “private pay.” It means paying for speech therapy yourself. Although speech therapy is well worth the investment, out-of-pocket costs can get pricey. However, costs can differ from practice to practice, so it’s worth shopping around. This is one reason to look into online speech therapy. Virtual speech therapy often costs less than traditional in-person therapy, which has more overhead costs.
For kids, look into speech therapy services offered at your public school. If your child needs speech therapy for stuttering, talk to their public school about services. Your child may qualify for speech therapy at school. One thing to note is that school speech therapy is often offered to kids as a group. Your child may not get the same one-on-one attention they would through a speech therapy practice. But group speech therapy is certainly better than no speech therapy at all, and school speech therapists work hard to give all their students the most time and attention possible. While you may have to put in time and effort to get speech therapy for stuttering covered, don’t give up! Your speech therapist is here to support and advocate for you along the way. And you can find more resources and tips from the National Stuttering Association in their Insurance Advocacy and Stuttering brochure.
