How to get insurance company to cover more of the speech therapy fee?

[Anonymous]

I have BCBS federal, in theory the cover ST but because no one really accepts insurance for speech therapy, I get $25 reimbursed per session. Out of $150, it isn't that much.

I was wondering if there's any way to get them to cover more? Any one could share experiences?

[Anonymous]

If you figure it out, everyone will be grateful.

I don't think it is possible. Carefirst pays doctors and other providers incredibly low rates for everything -- both in network and out of network providers.

Your only hope maybe proving there are literally in network providers available to you -- but the fact that CNMC accepts them makes it hard.

[Anonymous]

If the diagnosis is ASD, then it would probably be covered.

Other than that, good luck. You'll just have to find someone who is accepts your insurance.

[Anonymous]

We have pretty good health insurance (in every other respect) and yet I pay $7,000 out of pocket every year for speech and OT. I have not figured out a way to get insurance to pay more but we do max out our Flexible Health Spending account every year (here the max is $2550) and I get reimbursed from that. But of course all that means is that I didn't have to pay income taxes for $2550 of that $7000. Not a huge savings.

[Anonymous]

Anonymous wrote:I have BCBS federal, in theory the cover ST but because no one really accepts insurance for speech therapy, I get $25 reimbursed per session. Out of $150, it isn't that much.

I was wondering if there's any way to get them to cover more? Any one could share experiences?

We have bcbs fed, too. We have to drive farther to find a SLP who accepts our insurance. They are listed on the website of who is in network. Yes, it is challenging to find an in network SLP, but it can be done.

[Anonymous]

Have you asked them to cover you at an in-network rate because there are no in-network providers within a 25 mile radius (or whatever)? Sometimes that can happen. Theoretically when we had United Health they were willing to do this (and I had a letter to say they would). Actually getting the money was another thing altogether.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have BCBS federal, in theory the cover ST but because no one really accepts insurance for speech therapy, I get $25 reimbursed per session. Out of $150, it isn't that much.

I was wondering if there's any way to get them to cover more? Any one could share experiences?

We have bcbs fed, too. We have to drive farther to find a SLP who accepts our insurance. They are listed on the website of who is in network. Yes, it is challenging to find an in network SLP, but it can be done.

This. Or, get a waiver which is hard. I've driven 35-40 minute each way for one.

[Anonymous]

Drive out of DC. We have seen providers as far as Baltimore to find providers that take insurance.

[Anonymous]

Sorry I don't have an answer to the insurance coverage question. Just want to share what helped our son's speech. After he turned 2, we wasted over a year on the county services, ChildFind, etc. with almost no progress. Then we found a speech specialist at a preschool in Falls Church, and for $30/hr she did oral motor exercises with him. His speech dramatically improved in less than 3 months. Turned out, our son just had weak oral muscles that needed a "workout". Now he is almost 9 years old, he is doing great at school, both academically and socially, and actually is in the AAP program. The exercises/games basically work various muscles of tongue, cheeks, and lips, and parents can do it with the child at home. The key is to do it every day to strengthen the muscles.

[Anonymous]

Thanks to all for the replies.

I tried driving 45 minutes.....just for 30 minute session. Because the low reimbursement rate, the SLP wouldn't do an hour or even 45 min, which they'd have to charge as an hour. So driving 1 1/2 hours for a 30 minute session wasn't feasible.

My child has MERLD (which is both expressive/receptive), thanks for the suggestion about the mouth muscle exercises.

This is really stressing, we do use our flex spend but honestly. $5K isn't much when you have to pay for private ST and expensive asthma medications--yet, it's a lot of money every month.

I'll try to see if they'd cover based on the fact that no one close by (that is 15 miles) would do over 30 minutes sessions.

Thanks to all again

[Anonymous]

Our insurance only covers speech therapy if our child has been diagnosed with either a stroke or autism. in all other cases, we must pay 100% out of pocket. We pay $125 per week, which is $500 per month, for therapy. It really is expensive.

[Anonymous]

Do fed plans have a habilitative mandate? In MD if you can show your child was born with the problem requiring services it's supposed to be covered.

[Anonymous]

How about one of the university clinics. Exercises do nothing for MERLD.

[Anonymous]

What about an IEP? Students sometimes get speech therapy in their classroom, through the public school.

[Anonymous]

Anonymous wrote:What about an IEP? Students sometimes get speech therapy in their classroom, through the public school.

Np -- her dc probably has an IEP but therapy in the school is in a group, not one on one and is so different from private. A lot of kids with a diagnosis like MERLD truly need the one on one assistance of a private speech therapist. It is a shame that so many in the DC area are out of network. I moved to another state and assumed it was the same way and told a place that I would pay for a social skills group. They said, you're uninsured? in a sad voice. I, of course, was shocked to find out that they took my insurance. I laughed and explained that I was coming from a place where every provider was out of pocket. It's a shame that people can't get the care they need with insurance they pay for.