Insurance Coverage for Stuttering Evaluations
Does insurance pay for stuttering evaluations and therapy?
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 health insurance provider’s website, 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:
- Does my plan cover a speech-language evaluation for stuttering?
- Do I need a referral for that evaluation?
- Does my plan cover speech therapy for stuttering (ICD-9 307.0)?
- Before scheduling speech therapy, do I need to:
- Obtain a referral or script from my doctor?
- Obtain pre-certification from my insurance company?
- Select a speech therapist from within my network?
- Do we have a maximum number of therapy visits per year?
- Do we have a deductible or a co-pay?
- Do I need to schedule all of the visits by a certain date?
What to do if coverage is denied
If coverage for speech therapy for stuttering is denied, you should:
Call your insurance company to determine the reason for denial
Ask for a copy of your plan's policy for speech therapy services and an explanation for the denial in writing. Keep all confirmations, and for all telephone calls, write down:
- Who you spoke with
- When you had the conversation (time and date)
- Why services were denied
- What you can do next
Appeal the denial
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.
Contact the benefits coordinator at your place of employment
Provide the benefits coordinator 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 speech pathologist
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.
Contact your child's pediatrician
Ask your 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.
Write your own letter
You can also write a letter of appeal from your family’s point of view. Include the following information:
- Your child’s name, diagnosis (stuttering-ICD-9 – 307.0) and an explanation of how the problem affects your child and family.
- If your child has been in therapy, describe the progress that has been made as a result of therapy.
- List all of the information that you are attaching (physician letters, speech/hearing evaluations, treatment plans, progress reports).
- Thank them for their time and request a written response within 30 days.
The American Speech-Language-Hearing Association (ASHA)
The American Speech-Language-Hearing Association (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.
National Stuttering Association
Download their comprehensive Insurance Advocacy and Stuttering Brochure (PDF).
Ohio Speech-Language-Pathology Association
Look for insurance advocacy information on the OSLHA website by searching for “Insurance Coverage for Communication Disorders.”
Katrina Zeit, MHA, MA, CCC-SLP
Speech pathologist II
Cincinnati Children's Hospital Medical Center