1. Contact Information

This will include our team’s address, phone, email, EIN, and your specific therapists NPI number. Also included will be your name, date of birth, address, and insurance information.

2. Diagnosis/Services

In order for your insurance team to know exactly what your therapist provides, we must include an associated diagnosis code as well as the Current Procedural Terminology (CPT) codes.

3. Charges/Payment

Payment for your appointment will be taken prior to services. Our fee schedule is available upon request and will be discussed during patient intake. These applied charges, amounts paid, and final balances will be included.

Verification of Benefits

It is important that before your appointment, you give your insurance company a call. This number is typically on the back of your insurance card, which you will need available in order to verify your plan and benefits. Your insurance should take the time to explain what is needed in order to properly process a claim for you. This may include items such as a pre-authorization, pediatric referral, submission of therapy notes, or possibly a statement of medical necessity, along with others.

Even if your insurance plan covers “speech therapy” there may still be a “medical necessity” or “injury and illness” clause associated with reimbursement. Sometimes when verifying your benefits with the insurance company, you may come across this confusing clause. So, what does “medical necessity” mean for your coverage? Often times this clause means that if the specific speech impairment is not caused by a medical diagnosis, then your plan will not cover interventions associated with that impairment. Examples of these medical diagnoses might be: autism, down syndrome, dyslexia, apraxia, dysphasia, cerebral palsy, brain injury, etc.

You may ask, “well how do we ensure coverage when this clause exists?” Well, we are here to help. When applicable, our team will write a letter of medical necessity on your behalf which will accompany both a prescription from the referring physician, as well as the superbill. These documents along with a detailed medical history of the patient will give you the best chance of success when filing claims for reimbursement.