Using Out-of-Network benefits for speech/language services

Guide to Getting Reimbursement from Insurance

for 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 provider which means because we are not spending time chasing claims, we can…

drive to your house/daycare
spend more time with clients
dedicate more time to continuing education and creating unique treatment plans
treat a client for however much time they need, as often as they need, and for as long as is necessary versus an arbitrary number of visits dictated by insurance

Overall, we can provide more effective individualized care for more families being private pay. But that doesn’t mean your insurance company won’t reimburse you 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 and CPT codes which is found on our fee schedule***

Does my policy have out-of-network benefits and if so, is speech therapy covered?
What conditions/ICD-10 diagnostic codes are covered?
Are there any exclusions for speech therapy?
Is there a limit on the number of sessions my child can receive?
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?
Do I have a deductible that I need to meet?
How much will I expect to pay for services? Is there a maximum out-of-pocket expense?
What documentation is required for submitting a claim for reimbursement?

*** If your insurance company requires pre-authorization/certification please email Amanda at Amanda@functionalspeechnj.com immediately and upload all insurance information to the portal. ***

Don’t let insurance prevent you from providing your child with the support he or she needs. We are here to help you each step of the way. All clients will be provided a superbill free of charge; however, if your insurance provider requests additional documentation, it can be provided for an administrative fee.

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

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.