Procedures for Filing Insurance Claims
These are the procedures we recommend for
anyone trying to secure insurance benefits for speech and language services in
the state of Texas. Be sure to keep a copy of everything you send to your
insurance company. Also, document all phone contacts with the date,
time, and name of the person to whom you spoke.
- File claim (typically involves submitting a copy of a report, a
completed insurance claim form, an insurance printout, and sometimes a
- If your claim is denied, resubmit it. Points to include:
- Ask for a review of your claim and a written statement
(if not already received) of the reason that the claim was denied.
- If warranted, ask for your insurance company's
interpretation of Article of 3.70-2(G) Our understanding of this article
If denied again, send copies of all contacts (phone and
correspondence) you have had with the insurance company along with a cover
- Any group health insurance policy initiated,
renewed or amended after September 1, 1983 must offer the option
of coverage for speech and hearing disorders. If your policy doesn't
offer coverage for these disorders and you would like to have such
coverage, you should insist that it be added the next time the group
policy is renegotiated, which usually occurs on an annual basis. The
cost is estimated to be 30 to 40 cents per person per month.
- If coverage is provided for any type of
speech, language, or hearing impairment, then all speech,
language, and hearing impairments must be covered regardless of the
type, cause, or developmental stage at which the problem was first
- This law applies to any company providing
insurance or other health coverage in the state of Texas. This includes
Health Maintenance Organizations (HMO's) and Preferred Providers
Organizations (PPO's) but excludes self-insured and self-funded groups.
- Speech-language pathologists and audiologists
are the legal providers of these services. No doctor's orders are
required; however, if your doctor is willing to make a referral and it
would help you get insurance coverage you can send it in when you
resubmit your claim.
Texas Department of Insurance
Consumer Protection (111-1A)
P.O. Box 149091
Austin, Texas 78714-9014
Points to include
in the cover letter:
- Your understanding of article 3.70-2(G).
"An insurer may not offer or issue a plan that covers only
certain types of speech and hearing problems and not others. "
- If warranted, ask for a review of your
insurance company's interpretation of Article 3.70-2(G).
ask that our clients provide our office with copies of all of the above
information. We will use them in conjunction with our state association to help
improve insurance coverage for the communicatively impaired.
For more information refer to Health Insurance
Coverage for Speech-Language and Audiology Services, by the Texas Speech-Language-Hearing Association.
If you have questions or need more information you can contact me at:
Speech & Language Center, Inc.
Fort Worth, TX
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© 2001-2004 Overton Speech & Language Center, Inc.
revised: April 17, 2004