Abby Barnes, M.S., CCC-SLP
Many people wonder, “Is speech therapy covered by insurance?” For many health insurance plans, the answer is yes! But the process of getting coverage may be more complicated than you expect. In addition, not every speech therapy situation may qualify for coverage or reimbursement.
In this guide, we explain how insurance typically covers speech therapy for toddlers, children, teens, and adults. We also explain other options if your insurance doesn’t cover speech therapy or if your coverage is limited.
In this article:
1Is speech therapy covered by insurance?
2How do I know if my insurance covers speech therapy?
3How do you choose a speech therapist covered by insurance?
4How do insurance plans decide whether to cover speech therapy?
5Payment options if insurance won't cover speech therapy
6Affordable speech therapy is within reach
Is speech therapy covered by insurance?
Yes, speech therapy is often covered by insurance, but coverage can vary depending on your plan and provider. Many insurance plans, like Medicaid, Medicare, or employer plans, cover speech therapy if it’s “medically necessary.”
For example, speech therapy may be covered if it’s needed for a speech disorder caused by a medical condition or injury. But coverage, session limits, and approval rules can vary a lot.
How do I know if my insurance covers speech therapy?
Most healthcare plans will cover an initial evaluation from a speech-language pathologist (also known as an SLP or speech therapist). If you’re looking for a speech therapist, go straight to the source and call your health insurance company.
Here’s how to make sure you talk with the right person and get the answers you need:
Look on your insurance card for the company’s customer service phone number.
Place the call. You’ll likely be asked several automated questions before they connect you to the right department.
Tell the representative you’re checking on speech therapy coverage to find in-network providers. Ask for specifics about your coverage, including coinsurance, copays, and if out-of-network providers are covered at all.
Ask the representative whether online speech therapy is also an option. This way you can choose whether in-person or online speech therapy is best for you.
If you have an online account with your insurance, you may be able to skip the phone call and check this information online.
One thing to keep in mind: It’s a good idea to tell your healthcare provider or your child’s pediatrician that you’re looking into speech therapy. Your insurance company may require a doctor’s referral. This is essentially a written recommendation for speech therapy, like a prescription.
How do you choose a speech therapist covered by your insurance?
Once you understand your insurance network benefits and get a list of approved speech therapy providers in your area, it’s time to find a speech therapist!
The first step is to look up speech therapy providers online. You can call different practices to ask about their therapists’ experience, specialties, and availability. You may also want to ask when and where they offer appointments and if there is a waitlist to get started. Here are a few other things to ask about:
The therapist’s specializations: Ask if the therapist has experience with the issue you need help with. For example, you might need treatment for articulation issues in adults, stuttering, language delays in toddlers with autism, or speech recovery after a traumatic brain injury.
Payment details: Find out about co-pays, deductibles, and any out-of-pocket costs to avoid surprises later.
Teletherapy: If you’re interested in online sessions, ask if they offer teletherapy.
If you’re thinking about online speech therapy, Expressable is a great option. Learn more about payment options and insurance coverage at Expressable here.
How do insurance plans decide whether to cover speech therapy?
Your first visit with your or your child’s speech therapist will be an evaluation. The therapist will assess your communication skills, strengths, and weaknesses to see if speech therapy is needed. Then, the speech therapist will write a report and treatment plan. They will send it to your insurance company for review.
When reviewing a speech evaluation, insurance companies typically look at a few things:
The scores on the tests used during the evaluation. Insurance will want to see scores low enough to show a clear need for speech therapy.
The number of sessions, or time in therapy, that the speech therapist recommends. Insurance companies then decide how much of that recommended time they will cover.
The medical necessity of speech and language therapy. Insurance companies need proof that speech therapy is medically necessary. The speech therapist plays an important role here. Their job is to explain why they recommend speech therapy. They can also show why not receiving therapy may be harmful.
These factors will determine if your insurance will pay for more speech therapy sessions.
What if my speech therapy insurance claim is denied?
It can be very frustrating if insurance coverage is denied. The speech therapist may be able to provide more information to further make the case for coverage. However, it’s up to the insurance company to decide if they will reimburse.
Payment options if insurance won’t cover speech therapy
For some people, speech therapy is only possible if insurance reimburses the cost. But there are other options to think about when your insurance won’t cover speech therapy. Let’s take a look at some of them.
1 Use your HSA or FSA
Many people wonder if speech therapy is FSA-eligible. If you have a flexible spending account (FSA) or a health savings account (HSA), they will likely reimburse you for speech therapy services. Again, this is something to ask your insurance company about.
2 Consider out-of-pocket payment
Sometimes called “private pay,” out-of-pocket payment means paying for speech therapy yourself. While out-of-pocket costs can get pricey, there are also benefits to private pay.
For one, you don’t have to wait for your insurance company to say whether you qualify or for how long. Instead, a licensed, certified speech-language pathologist will determine your speech therapy needs. Plus, many people need speech therapy for reasons that aren’t directly tied to medical necessity. Children might need help with language development, which can be related to social and academic performance. Adults might want to improve their lisp or grow their public speaking skills. Insurance may not view these as medically necessary reasons. But if you’re paying out of pocket, you won’t have to worry about this.
That said, costs can differ from practice to practice, so it’s worth shopping around. This is another reason to look into online speech therapy. Virtual speech therapy often costs less than traditional in-person therapy.
3 Look into speech therapy services offered at your public school
If your child needs speech therapy, talk to their school. Many public schools offer speech therapy, and your child may qualify. 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 in school speech therapy as they would get through a private practice. But group speech therapy is certainly better than no speech therapy at all. School speech therapists work hard to give all their students the most time and attention possible.
Affordable speech therapy is within reach
Finding out whether speech therapy is covered by insurance can feel overwhelming. But when you understand your options and what to ask your insurance provider, it’s much easier. Whether your plan covers speech therapy or you need to explore other payment options, there are ways to ensure you or your loved one receives the necessary care. With a little research and planning, you’ll be on the way to the speech therapy support you need.
Ready to get started? Sign up for a free consultation call with one of Expressable’s specialists. We’re here to support you every step of the way—including with insurance!
