Author Topic: Speech Therapy  (Read 1122 times)

NancySJ

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Speech Therapy
« on: January 17, 2009, 02:01:23 PM »
My client is a speech therapist in Georgia.  She renders speech services to a child with autism.  The child has insurance which covers speech therapy services, but the family has a very high deductible and only 60 visit per calendar year. 

The visits will count towards their visit limit while the deductible is being satisfied.  Insurance covers speech at the reasonable and customary rate (we are not sure what the rate is as they could not answer that question when asked).  I’m afraid the family will run out of visits before they satisfy their deductible.  Since the provider is out of network insurance only pays 30% and the family is responsible for the remaining 70% so any amount that will be applied to the deductible will be very small.

I found an article on “Insurance coverage for Autism” and the article says “if a policy includes benefits for neurological disorders, it is prohibited from denying benefits for autism.  Such benefits are subject to the same terms and conditions as those for neurological disorders”.  Does this mean that even though they have speech coverage (but only 60 visits) that they have to consider this treatment under the neurological portion of the plan which has no limits on the amount of visits per calendar year? Or does it just mean that if the plan does not cover speech therapy services that they would have to cover speech simply because of the diagnosis of autism?

Here is the link to the article I am referring to:  http://www.cga.ct.gov/2006/rpt/2006-R-0793.htm

I hope you can help.
Thank you

Michele

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Re: Speech Therapy
« Reply #1 on: January 17, 2009, 08:53:50 PM »
The benefit they have of 60 visits for Speech Therapy is the same for autism as it would be for any other neurological disorder, so I'm afraid that the limit is still 60 visits.  I see what you are thinking, but the policy allows 60 visits for speech, for any covered diagnosis.  So whether it is autism, or another neurological disorder, they are going to allow 60 visits.  The policy is not saying that they allow unlimited benefits for neurological disorders, but only 60 speech visits for other diagnoses.

I'm not sure if I explained it correctly, but my interpretation of that article would be that only 60 visits would still be allowed.  They are not penalizing the patient for the diagnosis of autism, they are just stating that the policy allows 60 visits.

If anyone else knows more about this article or interprets it differently please respond.

Michele
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NancySJ

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Re: Speech Therapy
« Reply #2 on: January 18, 2009, 08:43:28 AM »
Michele,

Thank you so much for your reply.  You explained it perfectly.  I was thinking the same, but wanted to make sure I was right.

Thanks again,
Nancy