I am an “In-Network Provider” for Medicare.
I am an "Out-of-Network" provider for all other insurance plans.
What that means is that you will be responsible for paying your fee at the time of your appointment, and you may be able to use your Out-of-Network Benefits to reimburse you for my fees. I will provide you with a statement with all the necessary information that you can submit to your insurance company.
In order for insurance to reimburse you, I must designate a diagnosis code from the ICD-10. In the event you do not meet diagnostic criteria for a speech/language disorder, I will not be able to notate a diagnosis code and your insurance may not reimburse you.
Please note, even with a diagnosis code, there is no guarantee that your insurance will reimburse you. Here are some steps you can take with your insurance company to learn more about your benefits:
Call the number on the back of your insurance card & ask about your Out-of-Network (OON) benefits.
Ask to speak with someone regarding Out-of-Network benefits for Speech-Language Services or Speech Therapy.
Request approval for an intake and assessment/testing, and therapy sessions (request what you feel would be appropriate):
Evaluation of Language Comprehension and Expression 92523
Evaluation of Fluency 92521
Evaluation of Speech Sound Production 92522
Evaluation of Voice and Resonance 92524
Individual Speech Therapy 92507
Ask if you must complete a form, and if so, request a copy of this form. Ask where the form should be faxed or mailed and make a note of it.
Keep record of your phone calls with the insurance company and the information they provided.
Ask the insurance company what dollar amount you will be reimbursed for the CPT codes. They may say they will reimburse you based on a percentage. However, this is a percentage based on what they determine to be the “usual and customary rate” (UCR) – this is not necessarily the percentage of my fees.