Re: Speech Therapy-Insurance Coverage Issue- Need Help

[Guest guest]

Hi: Many insurance companies will not cover a billing code of 315.31 (expressive lang delay) because this is considered developmental. Developmental language delays are not covered under most insurance plans, however some language disorders are. They will cover a billing code of 299.00- Autism Disorder which is not developmental. If your child meets the diagnostic criteria of ASD, it would behoove you to obtain a formal diagnosis. I would also check with your SLP because your daughter may have a coexisting speech, language or voice disorder that may be compensated by your insurance co. An example of this would be a child who has difficulty producing language because of an underlying motor planning disorder. Both your insurance co and your SLP ashould be able to provide more information to you regarding whether your child's specific language diagnosis is covered under your plan. As a last resort, you could have both your pediatrician and SLP submit reports stating the necessity of speech therapy for your child.Good luck. To: sList From: supraco@...Date: Mon, 16 Apr 2012 21:12:41 +0000Subject: Speech Therapy-Insurance Coverage Issue- Need Help

Insurance Co. is BCBS. They just denied coverage for speech therapy for the following reason: the therapy is not being conducted to "restore" speech (e.g., unlike someone who had a stroke). Currently, my daughter's diagnosis is "expressive language disorder", I dont have an official spectrum diagnosis. Is anyone aware of any statutes and/or rules I can look to (that I can submit to the insurance co.) to change their coverage decision. She really needs the therapy because she is not getting the appropriate/enough services in her current place program. Any help would be greatly appreciated.

[Guest guest]

I would ensure you get a diagnosis letter that specifies autism 299.0 and every therapy you do is billed driven by that diagnosis, you can ask bcbs if that would do it, ask them what the autism benefit entitles

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flalawyer123 ;

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Speech Therapy-Insurance Coverage Issue- Need Help

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Mon, Apr 16, 2012 9:12:41 PM

Insurance Co. is BCBS. They just denied coverage for speech therapy for the following reason: the therapy is not being conducted to " restore " speech (e.g., unlike someone who had a stroke). Currently, my daughter's diagnosis is " expressive language disorder " , I dont have an official spectrum diagnosis. Is anyone aware of any statutes and/or rules I can look to (that I can submit to the insurance co.) to change their coverage decision. She really needs the therapy because she is not getting the appropriate/enough services in her current place program. Any help would be greatly appreciated.

[Guest guest]

Yes getting the autism diagnosis is important but also you need to say that the child had speech and lost it so that it meets the requirements that insurance companies have that there's been a loss of speech. This only happens when the child has autism.

I would ensure you get a diagnosis letter that specifies autism 299.0 and every therapy you do is billed driven by that diagnosis, you can ask bcbs if that would do it, ask them what the autism benefit entitles

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; To: <sList >; Subject: Speech Therapy-Insurance Coverage Issue- Need Help Sent: Mon, Apr 16, 2012 9:12:41 PM

Insurance Co. is BCBS. They just denied coverage for speech therapy for the following reason: the therapy is not being conducted to "restore" speech (e.g., unlike someone who had a stroke). Currently, my daughter's diagnosis is "expressive language disorder", I dont have an official spectrum diagnosis. Is anyone aware of any statutes and/or rules I can look to (that I can submit to the insurance co.) to change their coverage decision. She really needs the therapy because she is not getting the appropriate/enough services in her current place program. Any help would be greatly appreciated.

[Guest guest]

This is an excellent question for autism_insurance_information

Speech Therapy-Insurance Coverage Issue- Need Help

Insurance Co. is BCBS. They just denied coverage for speech therapy for the following reason: the therapy is not being conducted to "restore" speech (e.g., unlike someone who had a stroke). Currently, my daughter's diagnosis is "expressive language disorder", I dont have an official spectrum diagnosis. Is anyone aware of any statutes and/or rules I can look to (that I can submit to the insurance co.) to change their coverage decision. She really needs the therapy because she is not getting the appropriate/enough services in her current place program. Any help would be greatly appreciated.

[Guest guest]

United Cerebral Palsy of Broward in Sunrise has a FREE therapy program for

families who have no insurance or insurance has declined their request for OT,

SPL or PT therapy for children under 10. If you are interested ask for the

Director Ana Fraga Pardo at . Make sure you can provide a copy of

the denial letter. Ida

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> Insurance Co. is BCBS. They just denied coverage for speech therapy for the

following reason: the therapy is not being conducted to " restore " speech (e.g.,

unlike someone who had a stroke). Currently, my daughter's diagnosis is

" expressive language disorder " , I dont have an official spectrum diagnosis. Is

anyone aware of any statutes and/or rules I can look to (that I can submit to

the insurance co.) to change their coverage decision. She really needs the

therapy because she is not getting the appropriate/enough services in her

current place program. Any help would be greatly appreciated.

>