Insurance reimbursement for intensive aphasia treatment is a great way to help your family with therapy expenses, as well as maintain therapy for a longer time. Each insurance policy and coverage is different, but our experience will help you prepare you to get the most from your insurance.
Before coming to The Aphasia Center, contact your insurance company. The earlier you do this, the better.
If you have self-funded insurance through your employer, start with your broker/agent. Self-funded insurance plans can typically change benefits on a case-by-case basis.
If you have insurance (other than Medicare/Medicaid), call your agent/broker or customer service number on your insurance card.
- Tell them your doctor/therapist recommends intensive aphasia therapy. Ask how to get this covered.
- The insurance representative may ask for the CPT codes that would describe the therapy. Those codes are 92507, 92508 and 96105. They will tell you that they cover these codes.
- Now the tough part—explain that intensive therapy means that the client is in therapy for 5 hours per day for 4-8 weeks. Each hour is speech therapy. Therefore, there would be a total of 5 speech therapy sessions per day (codes 92507 and 92508). Expect confusion.
- The Aphasia Center is an out-of-network provider (OON). We do not accept insurance. There will be different rules for OON. If you have an HMO, they will not let you use an OON facility.
- Many people have gotten insurance to treat our facility as an In-Network provider. This is a higher reimbursement/coverage rate.
- We are not affiliated with any hospital or university.
- We are considered an outpatient therapy clinic. There are no physicians, nurses, social workers, etc on staff.
- Some insurers have required an evaluation with recommendations for treatment. Here is a template letter for MEDICAL NECESSITY
If they will reimburse for OON at a certain percentage, it is typically some pre-determined amount that they decide is “reasonable and customary” versus the amount of the actual charge.
Most insurance plans have a limit for speech and other therapies. For example, they may allow 20 visits per calendar year. Ask if each session counts as a visit, or if each day counts as a visit. If each day counts as one visit, you could potentially be reimbursed for some percentage of 20 days of therapy.
If your speech therapy benefits are limited, is there a way to increase those benefits?
Other important information:
Write down the name, date, and time of each person you speak with.
Try to get as much information in writing as possible.
Remember that insurance companies have hundreds of employees and each person will tell you something different. It’s a good strategy to speak with more than one person about this. Don’t believe what the first person tells you. Follow up and jump through the hoops.
The best strategy is to have one central person, such as a health care advocate, broker, or agent negotiate your reimbursement.
Now’s the time to start the process to get intensive aphasia therapy, we’ll save you a place 🙂