Confused… Anxious… Frustrated? – We Can Help!
Understanding your insurance benefits can be difficult and time-consuming. For this reason, Speech & Hearing Associates has dedicated employees who work one-on-one with you and your insurance provider to ensure that there are no surprises at the time of treatment.
Here’s what our patients have to say about our insurance team:
“Working with SHA’s insurance team has been a pleasure. They are true advocates for all the patients at speech and hearing. She walked me through the entire process making sure that I understood exactly what needed to be done. She was always on point and responded quickly to me as well as the insurance company. I cannot express enough my sincere gratitude for SHA. I only wish other parents in similar situations have the opportunity to work with such a knowledgable, caring, persistent individual.”
Most insurance companies will cover the cost of an audiological evaluation with a referral from your primary care physician (PCP). Medicare will cover the cost of a “diagnostic audiological evaluation” with a referral from your PCP. Some Unions and Private insurers also provide coverage for hearing aids.
Most insurance companies will cover the cost of a speech and language evaluation. It is your responsibility to know if your plan requires a referral from your primary care physician (PCP).
While most insurance plans do cover speech therapy, they typically do so only in the case of speech disorders that are due to an accident, injury, or illness. Most insurance plans have a speech therapy benefit that covers therapy for most conditions including developmental delay1. Other plans may exclude speech therapy that they consider to be educational, not medically necessary3 or not restorative5. Each plan is different, and much depends on the policy details purchased by the employer.
It is very important for you to review the benefits information provided by your health plan. Call your insurance company and ask about limitations and exclusions. Ask for clarification in writing from the plan administrator. Always keep a record of all correspondence and telephone calls, including the date, time, and name of the person you speak with. We are available to help you through this process.
Please keep in mind that when insurance does not cover speech therapy, it does not mean speech therapy is not needed. Regularly attended therapy sessions paired with regular practice at home can make a tremendous difference and result in relatively short-term results. For many children and adults, speech therapy is not something that will continue indefinitely. If you are paying out of pocket, we may be able to help you budget your sessions.
- One speech therapy session a week for 12 months will be 52 sessions. Paid privately, this will be $4160. ($346.67 per month)
- Two speech therapy sessions a week for 3 months will be 26 sessions. Paid privately, this will be $2080. ($693.33 per month)
- Two speech therapy sessions a week for 6 months will be 52 sessions. Paid privately, this will be $4160. ($693.33 per month)
If you compare speech therapy costs to other activities children engage in, such as music lessons, gymnastics, dance lessons, art lessons, etc, it is certainly not excessive. Your child’s ability to speak clearly and effectively will have a great impact on their future.
We participate with the following insurance companies:
Speech-Language Pathology
- Aetna (Including Aetna Medicare; no Aetna Better Health or Aetna Medicare Prime)
- Amerihealth
- Anthem Health BC/BS
- Cigna (Not in-network with LocalPlus or LocalPlus In-Network)
- Horizon BC/BS (Except NJ Family Care and NJ Horizon Health, both Medicaid-based plans)
- Empire BC/BS
- Humana/Tricare
- Local #1199
- Medicare
- Multiplan
- MVP Healthcare
- Starmark
- Trustmark
- Approved Providers For NJ Division Of Disability/Determination
Audiology / Hearing Aids
- Aetna (Including Aetna Medicare; no Aetna Better Health or Aetna Medicare Prime)
- Amerihealth
- Anthem BC/BS
- Cigna (Not in-network with LocalPlus or LocalPlus In-Network)
- Empire BC/BS
- Horizon BC/BS (Except NJ Family Care and NJ Horizon Health, both Medicaid-based plans)
- Local #1199
- Medicare (No hearing aid benefits)
- Multiplan
- MVP Healthcare
- Oxford
- Starmark
- Tricare
- United Medical Resources (UMR)
- United HealthCare (Including UHC Medicare, no UHC Community Plan, no Epic or HiHealth Innovations)
- Approved Providers for NJ Division of Disability/Determination
Please view our glossary for clarification on medical terms.