The simple answer to this question is, “it depends.” Fortunately, many, if not most, private health insurance plans provide good coverage for stuttering evaluations. Typically, the family only needs to pay their co-pay, if they have already met their deductible. Unfortunately, many private health insurance plans do not provide good coverage for speech therapy.
Your Benefits Handbook, which is typically located on your provider’s Web site, should provide details regarding your benefits and the requirements for obtaining coverage. If you have additional questions, you can call the member services telephone number found on the back of your insurance card. In an attempt to determine whether services are covered, you will want to ask the following questions:
If coverage for speech therapy for stuttering is denied, you should:
Ask for a copy of your plan's policy for speech therapy services and an explanation for the denial in writing. Keep all fax confirmations and for all telephone calls, write down:
Tell your insurance company that you would like to begin the process of appealing the denial. Make sure you find out how to initiate the appeal, where to send the material and whether there is a deadline for appealing. You can also ask how long the appeal will take and how will you be notified of their decision.
Provide him or her with all documentation of your conversations with the insurance representative and copies of all letters sent and received. Ask your employer's benefits coordinator to contact the insurance plan on your behalf.
Contact your child's speech pathologist and request the most recent evaluation report or progress note summarizing your child’s progress. Additionally, ask him to write a brief appeal letter that states why continued therapy is necessary.
Ask fyour child's pediatrician to provide written medical documentation that supports your child’s need for continued therapy or diagnostic services. The letter should also state that speech therapy services are a medical necessity.
You can also write a letter of appeal from your family’s point of view. Include the following information:
The American Speech-Language-Hearing Association (ASHA)
ASHA provides a variety of advocacy tools to help you with obtaining insurance coverage. Find out more by calling ASHA at 1-800-638-8255 or visiting and click on “About Health Insurance” and “Adding Speech, Language and Hearing Benefits to Your Policy.” A free Employer Insurance Packet is available for you to share and review with your employer.
Request their comprehensive Insurance Advocacy and Stuttering Brochure.
Look for insurance advocacy information on their Web site by going to and searching for “Insurance Coverage for Communication Disorders.”
Katrina Zeit, MHA, MA, CCC-SLP
Speech pathologist II
Cincinnati Children's Hospital Medical Center