Insurance & Payment

Getting information: Call the customer service number on the back of your insurance card, and tell them you want to get information regarding your benefits for speech therapy services. Ask the representative for a call reference number in case you need to review this information later.

Referral/Prior Authorization: Some plans require a doctor's referral and/or prior authorization before beginning therapy services. Ask if your plan requires these.

CPT Codes: Your insurance provider may ask for potential CPT codes that will be billed. Those may be 92522 or 92523 for speech/language evaluation, 92521 for stuttering evaluation, and 92507 for each therapy session.

ICD-10 Codes: Your insurance provider may ask for a communication disorder diagnosis code. I will provide you with an official code upon evaluation, but it may be one of these: F80.0 for speech sound disorder, F80.1 for expressive language disorder, F80.2 for receptive & expressive language disorder, and F80.81 for stuttering.

Deductibles: A deductible is the amount you have to pay before your benefits begin. If you have a $500 deductible, you pay the rate decided by the insurance company until you have paid $500. Only then will your benefits cover costs of service (minus a co-pay, if applicable). Ask your insurance provider what your annual deductible is, and if this service goes toward it.

Exclusions: Ask if there are any exclusions to your benefits. Some plans only cover services if the diagnosis is considered "medically necessary," or exclude services for children under 5 as part of developmental delay. 

Speech therapy is eligible for reimbursement with flexible spending accounts (FSA) and health savings accounts (HSA). They are not eligible for reimbursement with dependent care flexible spending accounts and limited-purpose flexible spending accounts (LPFSA). My secure card billing program charged HSA and FSA cards just like a debit card.

HSA Payment: You typically have two options. The first is to use a debit card that’s tied to your HSA. When you first opened your account, most providers send a debit card for convenience. The other option is to pay the bill on your own and request a reimbursement from your HSA provider. In this scenario, you’ll typically need to provide a receipt to prove that the transaction was eligible.

FSA Payment: There are two main ways that FSA funds are distributed:

Debit cards: If the employer has set up the FSA with a debit card, employees have direct access to their funds and can pay for expenses at the point-of-sale without needing to submit receipts or other documentation.

Reimbursements: If the employer hasn’t given employees direct access to their funds, employees will need to pay for their expenses first, then submit the proper documentation to the FSA administrator for reimbursement. Reimbursements can come in the form of direct deposits to employees’ bank accounts or checks mailed to their address.

Bookmark Speech, Language, & Literacy Services does not accept insurance other than Molina Healthcare of Washington and Health Savings Accounts. Directly contracting with insurance companies is a long process and often prevents us from offering fair and competitive rates. 

Insurance plans often have high deductibles, which means you must pay the rate decided by the insurance company out of pocket before your insurance even kicks in. 

Insurance companies often require a prior authorization for services, which means you often need a doctor's referral, and the insurance company will determine how many sessions you or your child are eligible for. Many plans limit speech sessions to only 12 per year (that's 3 months of weekly sessions).

In some situations, an insurance company might have a maximum amount they will pay, and services will be cut off before the therapy plan is complete.

Some insurance companies might say some diagnoses are "not medically necessary," which is often the case for developmental delays, dyslexia, or stuttering. When this happens, you are met with a large and unexpected bill when you thought services were covered.

Selecting private pay gives you more freedom over who your speech therapist is, and how you or your loved one is served.

It is important to compare all of your options to determine if utilizing your insurance plan is best for you and your goals. Please be advised that the information offered here reflects personal opinion and should not be interpreted as a financial or medical recommendation.

After services are paid for, Bookmark Speech can provide a superbill for you to submit to your insurance provider to be considered for reimbursement. There is no guarantee of reimbursement for out of network plans, and it is up to each plan how much they will reimburse, if at all. You can submit the superbill on your own behalf to your insurance company for out-of-network reimbursement. 

It is highly recommended that you check with your insurance company to determine what out-of-network speech services are included in your plan, and if there are any restrictions.