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 superbills/invoices you need to file an out-of-network claim (information on superbills/invoices include description of services rendered, ICD-10 diagnosis codes specific to your child’s diagnosis, charges and CPT codes for each treatment). 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).



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.