How can I use Out-of-Network benefits to cover speech/language services?

Having your child’s speech therapy reimbursed by insurance may seem like a daunting task, but it also may be well worth it. FUNctional Speech + Language LLC is a private pay and out-of-network provider, which means that I don’t file and bill insurance claims directly with any insurance company. But that doesn’t mean your insurance company won’t reimburse for out-of-network services!


By asking your insurance provider the questions below, you can better understand your coverage for speech/language therapy services:


***Make sure you provide the representative with your child’s age as some coverage is dependent on the age of the child**

  1. Does my policy have out-of-network benefits and if so, is speech therapy covered?

  2. What conditions/ICD-10 diagnostic codes are covered?

  3. Are there any exclusions for speech therapy?

  4. Is there a limit on the number of sessions my child can receive?

  5. Do I need to obtain a prescription or pre-authorization prior to evaluation and/or treatment? If the answer is yes, what address/fax number can documentation be set to?

  6. Do I have a deductible that I need to meet?

  7. How much will I expect to pay for services? Is there a maximum out-of-pocket expense?

  8. What documentation is required for submitting a claim for reimbursement?


Don’t let insurance prevent you from providing your child with the support he or she needs. I am here to help you each step of the way and provide all necessary documentation you need to file an out-of-network claim (included but not limited to an invoice describing exactly what services were rendered, ICD-10 diagnosis codes specific to your child’s diagnosis, charges and CPT codes for each treatment).


Your out-of-pocket medical expenses can also be reduced if your employer offers a Flexible Spending Account (FSA) or Health Savings Account (HSA).



NOTE: In accordance with NJ P.L. 2018, c. 32 , I must inform you that may be covered in network at a lesser rate and have every right to pursue finding a provider who accepts your insurance.


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