Legally reviewed by Scott Glovsky , Trial Attorney & Founder
Page Contents:
What is Speech Therapy?
Since communication is essential in our world, a speech impediment can make life difficult. Speech therapy may be implemented for a variety of speech problems and disorders, including:
- Pronunciation issues (lisps, or swapping certain sounds for others)
- Partial loss of speech due to brain damage from a stroke or TBI
- Language disorders
- Swallowing problems
- Neurological diseases that cause speech disorders
- Fluency disorders such as stuttering
- Voice disorders, including a hoarse, strained, raspy, or nearly silent voice
Various speech therapy techniques may be used, depending on the specific disorder or issue. A series of treatment sessions is typically prescribed, with each session lasting from 30-60 minutes. Speech therapy may be offered in rehabilitative care centers, special needs schools, children’s facilities that specialize in speech therapy, or from a one-on-one specialist who is trained in breathing, speech, and voice.
Why Could Your Speech Therapy Be Denied by Insurance?
Your speech therapy could be denied for a simple reason such as missing information on your claim. This is something that can be easily fixed; you will provide the missing information, correct any erroneous information, and re-submit your claim. More often, however, speech therapy denied by insurance is the result of an insurance company that simply doesn’t want to pay for the necessary therapy. These denials will be “cloaked” behind such wording as “not medically necessary,” or possibly “experimental or investigational,” although speech therapy has been an approved treatment for decades. That being said, some insurers may only cover speech therapy when the disorder results from an accident, illness, or injury, excluding other diagnoses.
What Should You Do If Your Speech Therapy Is Denied by Insurance?
Speech therapy denied by insurance can benefit significantly from having a strong legal advocate like attorney Scott Glovsky on your side. You may need a letter from your doctor that details why speech therapy is important for you or a family member. If this does not result in a reversal of the speech therapy denial, Scott can help you file an internal appeal. If the internal appeal is unsuccessful, Scott may recommend that you file an external appeal with a neutral third party, who will determine whether your insurer will be required to pay for speech therapy. Scott’s recommendation whether or not to file an external appeal will depend on your particular situation.
Which Insurance Companies Are More Likely to Deny Speech Therapy Treatment?
Speech therapy could potentially be denied by any insurer. A decade ago, the state of California fined three of the state’s biggest health insurers after it was determined that speech therapy claims were being denied. Health Net was fined $300,000 for repeatedly denying valid claims for speech therapy. Anthem Blue Cross and Blue Shield were also warned to stop denying medically necessary speech and occupational therapy in cases of developmental disabilities, autism, and other medical conditions. Companies that could deny your speech therapy claim include:
- Anthem Blue Cross
- Blue Shield
- Health Net
- Kaiser
- United Healthcare
- Aetna
- and others
Is Speech Therapy Costly?
As of 2023, the average cost of speech therapy in the United States ranges from $100 to $300 per hour. Since speech therapy can last months or even years, many insurers sometimes try to avoid paying. Insurance companies generally do this by stating that speech therapy is not medically necessary. Scott Glovsky and his legal team will work hard to show that the prescribed speech therapy is medically necessary, helping you or a loved one get the treatment you need.
Could a Letter from Your Doctor Help Reverse Speech Therapy Denied by Your Insurance?
Obtaining a letter from your general practitioner physician, as well as the speech therapist referred to you by your GP can be crucial in proving that you or a loved one need prescribed speech therapy. Your insurer may block you at every turn, which can be frustrating. When you are feeling overwhelmed, don’t give up. Attorney Scott Glovsky can turn an impossible situation into approval for the speech therapy prescribed.
How the Law Offices of Scott Glovsky Can Help When Your Speech Therapy Claim Has Been Denied
Attorney Scott Glovsky and his legal team bring passion, commitment, and hard work to every single case they take—and they have the results to back that up. With a solid record of positive results for clients, Scott provides the highest level of personal care and support to every client. Scott only takes cases he believes in, with a mission of helping those who have been wronged. At the Law Offices of Scott Glovsky, we will listen to you, support you, be responsive to you, and always put your needs first while ensuring you are treated with dignity and respect. Contact the Law Offices of Scott Glovsky today for the help you need with your speech therapy denied by insurance issue.
