[Overton]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.

  1. File claim (typically involves submitting a copy of a report, a completed insurance claim form, an insurance printout, and sometimes a receipt).
  2. If your claim is denied, resubmit it. Points to include:
    1. Ask for a review of your claim and a written statement (if not already received) of the reason that the claim was denied.
    2. If warranted, ask for your insurance company's interpretation of Article of 3.70-2(G) Our understanding of this article is that:
      • 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 noticed.
      • 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.
  3. If denied again, send copies of all contacts (phone and correspondence) you have had with the insurance company along with a cover letter to:

Texas Department of Insurance
Consumer Protection (111-1A)
P.O. Box 149091
Austin, Texas 78714-9014
Phone 800-252-3439
Fax 512-475-1771

Points to include in the cover letter:

    1. 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. "
    2. If warranted, ask for a review of your insurance company's interpretation of Article 3.70-2(G).

We 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:

Overton Speech & Language Center, Inc.
Fort Worth, TX
(817) 294-8408

info@overtonspeech.net

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Copyright 2001-2004 Overton Speech & Language Center, Inc.
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Last revised: April 17, 2004