Unfortunately for many, the term “health insurance company” has become a synonym for “red tape.” But this doesn’t necessarily mean that your kid needs to suffer. Denial of benefits such as speech therapy need not result in denying your child the speech therapy benefits he/she so much needs and so much deserves. But it does require you to be educated to truly “make it happen.”
Where to begin? You guessed it! You need to understand the common reasons for the speech therapy being denied in the first place to correct the problem. After you carefully review your policy and submit your claim together with all supporting documents, and your claim is still rejected, just remember you can always file an appeal.
1 – Speech Therapy is not considered a “Medical Necessity.”
Perhaps you are already aware that most health insurance companies will refuse to cover any claim not considered a “medical necessity.” In other words, if the problem cannot be shown that the most likely source is a known disease, injury or chronic condition, you can be sure that the health insurer will most likely reject the claim.
The truth is that it isn’t so easy to associate the speech disorder with a medical condition. While many speech disorders spring from abnormal neurological conditions, because the specific cause is unknown, speech therapy will often be denied. What to do? Make sure you have documents from your child’s doctor or speech therapist that insist that a medical condition exists.
2 – The Speech Disorder is Considered a Developmental Disorder
Sometimes the Health Insurer will deny the claim due to a misinterpretation of the word “Developmental”. When a particular speech disorder is considered a developmental disorder, the claims officer assigned to the case may assume that developmental means that as the child develops he/she will “grow out” of the impediment and hence not require speech therapy.
Although the claims officer may be correct unless you are fortunate enough to be endowed with prophecy, how could he possibly know that at this point? Better to err on the side of caution and get the speech therapy your kid needs. And by the way, request that your speech therapist not to use the word “developmental” in either the paperwork or medical billing code.
3 – Let The Public School System Take Care of It
Another common tactic used by health insurance companies is to deny services that could be provided by the public schools. If your child’s school can take care of the problem, what do you want from the insurance company? While technically this may be correct, you need to know if the school can adequately service your child. If not, get the speech therapy that will.
And even if the school has services, the school may have an extensive waiting list so that practically speaking your child will not receive the speech therapy he/she needs in a timely manner. Alternatively, your child may not qualify for the speech therapy services that the school provides since his/her standardized test scores may not indicate an educational handicap.
Bottom line: as we all know, dealing with insurance companies can be a hassle at best and sometimes nothing less than exasperating. So stop knocking your head against the wall, get informed, be persistent and be sure to get the speech therapy that your child truly needs to succeed in school, and in life!