How to Call Your Insurance Company to Check Speech Therapy Coverage: A Guide for Parents from an SLP
Navigating health insurance can feel overwhelming—especially when you're advocating for your child. As a speech-language pathologist (SLP), I often hear from parents who are unsure how to begin the process of determining whether their child’s speech therapy services will be covered. While every insurance plan is different, there are some universal steps that can make the process smoother and more successful. Below is a parent-friendly guide to help you confidently call your insurance company to verify coverage for speech therapy.
📞 Step 1: Gather Your Information
Before you make the call, have the following information ready:
Your insurance card (Member ID and Group Number)
The name and date of birth of your child
Your SLP’s information, including the name of the practice, tax ID, and NPI number (your provider can supply this)
The diagnosis or reason for services, if known (e.g., speech delay, articulation disorder, autism)
Procedure codes (CPT codes) that your SLP plans to use (e.g., 92507 for individual speech therapy)
🗣 Step 2: What to Say When You Call
Use this basic script when calling the Member Services number on the back of your insurance card:
“Hello, I’m calling to check benefits and coverage for outpatient speech therapy for my child. Can you help me understand what’s covered under our plan?”
Then ask the following key questions:
✅ Coverage Questions
Is outpatient speech therapy covered under my plan?
Does my plan cover speech therapy for developmental delays, or only for medical diagnoses or injuries?
Are there any exclusions for speech therapy services (e.g., articulation, autism, stuttering, expressive/receptive language delays)?
💳 Financial Responsibility
What is my copay or coinsurance per visit?
Do I need to meet a deductible first? If so, how much has already been met this year?
Is there a limit to the number of visits per year or per condition?
📋 Authorization & Referrals
Is pre-authorization or a referral from a pediatrician required?
Can services be provided out-of-network if I don’t have an in-network SLP available?
📌 Step 3: Document Everything
While you’re on the call, write down:
The name of the representative you spoke with
The date and time of your call
All the answers you received
This information can be incredibly helpful later if you need to appeal a denial or request a single-case agreement.
📤 Step 4: Follow Up With Your SLP
Once you’ve confirmed coverage and requirements, share what you’ve learned with your SLP. They may be able to help you:
Submit the proper documentation
Provide a referral or letter of medical necessity
Guide you through pre-authorization or billing
Some private practices may also offer superbills, which allow you to submit claims directly to your insurance company for possible reimbursement, even if the provider is out-of-network.
🧠 Final Tips
Ask for everything in writing. Request a copy of your benefits in writing via email or the patient portal.
Check coverage each calendar year. Benefits can change from year to year—even with the same employer.
Be persistent. If you’re told something is not covered, ask for the section of the policy that outlines this and consider filing an appeal if needed.
🙋♀️ You're Not Alone
Insurance language can be confusing, but you are your child’s best advocate. Many SLPs, including myself, are happy to guide you through this process. Don’t hesitate to reach out with questions. With a little preparation, you can feel more confident making that call—and getting your child the support they deserve.