Reply to Health Insurance for Dyslexia Therapy

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[quote=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.[/quote]

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