We accept Florida Medicaid.
We accept Medicaid. Medicaid requires a prescription from your physician and authorization.
Commercial Insurance:
Most commercial insurances do not cover speech therapy as they deem it to be developmental in nature. Therefore, we provide services on an out-of-network and private pay basis. As an Out-of-Network provider, we are not under contract directly with insurance carriers. This allows us to schedule an appointment almost immediately and eliminates any restraints placed on therapy services by commercial insurance plans. Fees for services are due at the time they are rendered. As a courtesy. we can provide you with the appropriate documentation to obtain reimbursement from your insurance company via a Superbill. Provision of a Superbill does not guarantee reimbursement as each carrier has unique policies and limitations. If you plan to submit claims to your insurance company for reimbursement, a physician's order will be required prior to scheduling an evaluation.
Get the most out of your insurance benefits.
be your own advocate
Insurance coverage for speech therapy most often excludes coverage for any service that treats a delay or disability that is considered “developmental” in nature. Many insurance companies define eligibility of medical necessity only for conditions that result from a specific injury or illness, such as a stroke or traumatic brain injury.
Very few plans under the Affordable Care Act, also known as “Obamacare,” cover speech-language pathology services. If therapy is covered by insurance, the insurance company may apply exclusions, conditions or they may approve only a limited number of therapy sessions within a defined period, for example 12 sessions over a six month period. Others have very high deductibles or co-payments of $45, $70 and even as high as $100 per visit. You can often receive a 30 minute session for under those rates and use your out-of-network benefits to recover most of that amount, which can actually be a cost savings. Using your out-of-network benefits to recover 60-80% of what you paid can help reduce the financial burden of services significantly.
Some plans have gap insurance coverage and you can negotiate better out-of-network rates. You will have to call them to pursue this as they will not readily offer you lower out of pocket rates unless you ask for them.
It is important that you contact your insurance company and get all the information you need to make informed decisions. Ask them to explain exactly what your reimbursement rates for speech therapy are per your plan.
Consider:
What is your deductible or the amount of money you must pay before your benefits kick in?
Does this amount apply to each member of your family or can payments be combined?
Once your deductible is met, how much of each session will the insurance cover?
You will need to ask whether your pediatrician or physician has to make the referral and if he/she needs to write a “letter of medical necessity” to the insurance company. It is always recommended to obtain a prescription before the evaluation and to have the physician sign the plan of care once it is received from your provider. You also need to know if the doctor must generate an authorization number that the speech-language pathologist will need in order to file the claim.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) may also be used to offset the cost of speech therapy. Check your plan. Many allow debits provided directly to a provider via an HSA credit card.
Don’t panic if your claim is denied. You do have options. Remember that the squeaky wheel gets the oil. On your EOB, or Explanation of Benefits, will be a code that tells why the claim has been denied. This may be on a separate page or on the back side of the form. Sometimes the insurance company just wants more documentation to support the medical necessity of the services provided either from the speech-language pathologist and/or from the physician. If it is unclear why they are denying the claim, call the company. If they are denying coverage then you are entitled to an appeal.
You should always appeal a denied claim. The insurance company will usually tell you how many days you have to submit a written appeal. It is typically 60-90 days. You will want to collect the information received when the verification of benefits was completed and keep a record on file with the day, time and name of the representative you spoke with. Ask for a reference number. You will also want to submit the speech therapy documentation and any supporting physician’s notes. Many insurance companies will pay a claim if there is evidence that the deficit is possibly the result of a physical problem such as recurrent ear infections or evidence of a neurological condition such as dysarthria or apraxia.
Your physician can be an advocate and a helpful resource, especially in providing documentation of any of the above problems. It might also be helpful to ask the physician to write a letter stating that speech-language therapy is “medically necessary.”
Insurance companies are not used to people appealing their denials. The majority of appeals for speech-language therapy are reversed. Don’t easily give in or take “no” for an answer.
Faxing your appeal and/or sending it via certified mail helps to ensure they receive it. After a week, we recommend that you call your insurance company and ask at what the status of your appeal is and whether or not they have made a determination. It is crucial to get the names of the people you speak with and their direct extension or phone numbers, if possible. Keep the date and time as well since many of the calls are recorded for quality assurance purposes. You can often request that a supervisor reviews a call in which certain information was provided to you. This has yielded favorable results at times. Call frequently until a decision is made so they will know this is very important to you.
Connect is not currently a participating provider for Medicare or Medicaid programs. Beneficiaries of these programs must see a participating provider for skilled therapy, but may participate in our private pay educational webinars or non-therapy wellness programs.
We offer secured credit card processing through our patient portal.
Connect works with schools serving students receiving the McKay Scholarship or Step Up and with school districts to provide services to students enrolled in special education programs.
