Health Insurance for Dyslexia Therapy

[Anonymous]

I wanted to let parents know that some health insurance plans do indeed cover some dyslexia remediation. Most of us (parents and therapists/tutors) have understood that health insurance would not cover remediation unless it was provided by a speech language pathologist and billed as speech therapy. But we are finding that isn't true. Multiple health insurance plans cover the diagnosis code for specific reading disorder, and some will reimburse families for academic language therapy as long as the family and the provider provide documentation in very specific ways. Insurers probably won't cover anything called tutoring, but ASDEC trains therapy-level providers so many of our locally-trained people will qualify.

If you want to know if your health insurance plan covers dyslexia therapy you may not get an accurate answer by just asking them that. My insurer said no when I asked that way. But when I asked if they cover "diagnosis code F81.0, specific reading disorder" they entered the code into the database and it is covered. You will then need to see if they will cover academic language therapy, which is a documented treatment for specific reading disorder.

In order for you to get reimbursed there are steps the academic language therapist needs to take, such as getting an NPI, providing you with a super bill, and perhaps doing a treatment plan and filling in a request for prior authorization. It's a hassle. But so far I have seen insurers approve reimbursement of some % of the total cost of each session, some with annual limits on number of sessions and some with no annual limit. Given the cost of therapy the hassle seems worth it!

I am an academic language therapist (not yet certified, but in private practice) and while I have extra time this summer I am learning and sharing as much as I can about health insurance for dyslexia services. So thought I'd post this info here. If anyone with a kid with a documented diagnosis of specific reading disorder would like to chat about navigating health insurance I'm glad to share what I have learned. I can share general info here, but it gets specific and wonky and sensitive when you dig in, so for anything specific I'll post how to contact me, if that would help any one.

As a mom of a dyslexic kid who is off to college in a couple of weeks I well remember our days where tutoring was the second largest line item in our household budget, second only to the mortgage, and meant that we couldn't go on vacation or replace the dying furnace. Hopefully health insurance could make the cost a little less of a burden for some folks.

[Anonymous]

If you’re thinking about going into private practice I suggest not dealing with insurance especially if you’re a sole provider. Do private pay, give the parents an itemized bill, they can seek reimbursement if they want. The amount of headaches and hassle insurance billing will cause you is not worth an extra client. If you have do to insurance billing and want to expand then hire someone dedicated just to insurance, everyday will still be a hassle though but you just won’t be the one dealing with it. When it gets to the point where what the insurance wants and what’s best practice conflict, then you’ll need to think long and hard about what comes first- the client or the money. Hopefully you move to private pay only and put the clients first.

[Anonymous]

Anonymous wrote:If you’re thinking about going into private practice I suggest not dealing with insurance especially if you’re a sole provider. Do private pay, give the parents an itemized bill, they can seek reimbursement if they want. The amount of headaches and hassle insurance billing will cause you is not worth an extra client. If you have do to insurance billing and want to expand then hire someone dedicated just to insurance, everyday will still be a hassle though but you just won’t be the one dealing with it. When it gets to the point where what the insurance wants and what’s best practice conflict, then you’ll need to think long and hard about what comes first- the client or the money. Hopefully you move to private pay only and put the clients first.

My post was just about reimbursement - so yes, having the parent submit an itemized bill (called a super bill) to the insurance company for reimbursement. Direct billing to insurance is something I haven't tackled and don't know if I ever will, though it would expand access. One step at a time.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you’re thinking about going into private practice I suggest not dealing with insurance especially if you’re a sole provider. Do private pay, give the parents an itemized bill, they can seek reimbursement if they want. The amount of headaches and hassle insurance billing will cause you is not worth an extra client. If you have do to insurance billing and want to expand then hire someone dedicated just to insurance, everyday will still be a hassle though but you just won’t be the one dealing with it. When it gets to the point where what the insurance wants and what’s best practice conflict, then you’ll need to think long and hard about what comes first- the client or the money. Hopefully you move to private pay only and put the clients first.

My post was just about reimbursement - so yes, having the parent submit an itemized bill (called a super bill) to the insurance company for reimbursement. Direct billing to insurance is something I haven't tackled and don't know if I ever will, though it would expand access. One step at a time.

I found your OP very useful just trying to warn you before you go insurance route. I had to stop accepting it because their requirements went against best practices. Great that you’re exploring, good luck with your new adventures!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re thinking about going into private practice I suggest not dealing with insurance especially if you’re a sole provider. Do private pay, give the parents an itemized bill, they can seek reimbursement if they want. The amount of headaches and hassle insurance billing will cause you is not worth an extra client. If you have do to insurance billing and want to expand then hire someone dedicated just to insurance, everyday will still be a hassle though but you just won’t be the one dealing with it. When it gets to the point where what the insurance wants and what’s best practice conflict, then you’ll need to think long and hard about what comes first- the client or the money. Hopefully you move to private pay only and put the clients first.

My post was just about reimbursement - so yes, having the parent submit an itemized bill (called a super bill) to the insurance company for reimbursement. Direct billing to insurance is something I haven't tackled and don't know if I ever will, though it would expand access. One step at a time.

I found your OP very useful just trying to warn you before you go insurance route. I had to stop accepting it because their requirements went against best practices. Great that you’re exploring, good luck with your new adventures!

Thanks for the heads up! I’m sorry to hear you had to choose between best practice and insurance. Is this for dyslexia or some other type of therapy?

[Anonymous]

As a parent of a dyslexic child, thank you for posting!

[Anonymous]

Any guidance on federal plans that reimburse?

[Anonymous]

Anonymous wrote:Any guidance on federal plans that reimburse?

I haven’t had any luck yet being able to do a survey of which plans cover dyslexia and which don’t, unfortunately. It has been a process of calls and discussions with each individual plan. The number of plans is endless, and getting them to tell you if they cover dyslexia or not is pulling teeth.

As open enrollment comes up it’s a really good question, though. Do Feds have some sort of employee navigator to help pick plans?

Remember to ask if they cover the diagnosis code, not “dyslexia.”

[Anonymous]

Can you share info on the specific diagnostic codes and information that will need to be provided?

[Anonymous]

Anonymous wrote:Can you share info on the specific diagnostic codes and information that will need to be provided?

Sure! If your child has a diagnosis of dyslexia or specific learning disorder with impairment in reading or specific reading disorder, the code is F81.0. If you haven’t gotten a diagnosis from a medical professional that documents the diagnosis you will need that before insurance will reimburse. But you should be able to get your insurance company to tell you whether they cover the diagnosis or not before you invest more time.

[Anonymous]

Be aware OP that this opens the you up to paperwork demands. Superbills are different form of billing insurance as an out of network provider and that comes with all documentation demands: prior authorization, letter of medical necessity, SOAPs, evaluations, progress updates, etc. Superbills open the door to the paper chase that nearly ALL cash pay providers want to avoid.

[Anonymous]

It’s true, PP. I’m finding that there is indeed paperwork. But the alternative is many people can’t afford therapy, right? I am willing to give it a go.

I will say that a proper documentation platform helps - SimplePractice has super bill functionality built in, plus treatment plans, diagnosis and service codes, etc. It costs more than TutorBird but does more, too.