[Reprinted from the Texas Speech-Language-Hearing Association Consumer Newsletter, vol. 3, no.1, September 1989.]
DOES YOUR HEALTH INSURANCE COVER SPEECH-LANGUAGE AND AUDIOLOGY SERVICES?
If coverage of speech-language and audiology services is included, the policy cannot discriminate on the basis of:
Type of problem
Age of onset
Cause of problem
This means that the insurance company cannot choose to cover only some types of communication disorders. No matter the type of problem, when the problem began, or the cause, if your insurance plan includes speech-language pathology (sometimes called speech therapy) and audiology services, your claim should not be denied if the services are provided by a licensed speech-language pathologist or audiologist.
In 1989, the Texas Legislature passed a law,
saying that group health insurance plans written or issued out-of-state to
HOW CAN YOU BE SURE YOU HAVE THESE BENEFITS?
HOW DO YOU FILE A CLAIM?
When you are preparing the necessary paperwork to file a claim, ask your speech-language pathologist or audiologist for assistance in providing the appropriate diagnosis and other information.
Billing procedures should be discussed with your clinician or the bookkeeper at the facility where the services are being provided. Ultimately, however, payment for services rendered is your responsibility.
WHAT IF YOUR CLAIM IS DENIED?
If your claim is denied, ask the insurance
company for a letter or other written documentation stating the reason the
claim was denied. Share this information with your speech-language pathologist
or audiologist and request his or her assistance in appealing the denial.
Additional information may be required. Then resubmit the claim with the
additional information or request that the insurance company perform a medical
review of your case. If your claim is again denied and you believe that your
policy includes coverage, contact Texas Department of Insurance,
Consumer Protection (111-1A),
WHAT IF YOUR EMPLOYER IS SELF-INSURED?
Although they are not governed by the Texas State Board of Insurance, many companies that are self-insured have elected to cover speech-language and audiology services. Contact the person responsible for benefits at your place of employment and request that this coverage be a part of your health insurance plan.
FOR ADDITIONAL INFORMATION ON INSURANCE COVERAGE VISIT
For information on private health care plans, Medicare, Medicaid, how to appeal insurance denials and alternative sources for health care assistance visit the following web site: www.asha.org/public/coverage.
For information on the importance of providing speech, language and hearing benefits, the cost of adding this coverage to your current insurance policy and examples of appropriate speech, language and hearing benefits visit: www.asha.org/public/add-benefits.
If you have questions or need more information you can contact me at:
Speech & Language Center, Inc.
Fort Worth, TX