Obtaining insurance coverage for the evaluation and treatment of stuttering can be difficult. Many National Stuttering Association (NSA) members have reported their claims have been denied or their insurance policy did not cover stuttering. The NSA's Insurance Advocacy Committee was established to help consumers with third-party reimbursement issues.
The goal of this article is to help adults, and parents of children who stutter, utilize their insurance coverage. This paper is based on the brochure Insurance Advocacy and Stuttering, available free of charge at www.westutter.org.
The first step is to carefully review your policy. Each insurance plan is different -- and there may be differences depending upon which group you belong to, or which policy was negotiated by your employer. In other words, having the same insurer as a friend or colleague may or may not indicate the same or similar coverage.
Read your policy before your initial evaluation to know if recommended services are covered under your plan. Check with your insurer directly if there is any question about your benefits. Sometimes, even plans that cover "speech therapy" in general will only cover stuttering in particular situations. Unfortunately, just asking if you are covered for "speech" (or even "stuttering") therapy may not be enough to determine if you are covered for the specific treatment you need. Therefore, when asking about coverage, you might want to inquire as to the most appropriate diagnostic and procedure codes your Speech Language Pathologist (SLP) should use to help assure the codes used accurately reflect the coverage you have.
To reduce confusion, take detailed notes during all discussions with the insurance company. You may receive different information from various people at the insurance company and it will be important for you to have documented information from each of these sources as you move through the process. In other words, always write down the name, date and time of your phone calls, as well as the name, phone number and department of the person you're speaking with and the exact answer they offer to your query.
The second step in obtaining insurance coverage is usually based on a complete diagnostic evaluation from your licensed and certified SLP. A detailed diagnostic report can help you acquire coverage. Speak with your SLP to ensure the report describes all aspects of stuttering, not just disfluencies produced. This is particularly important as many people experience a significant negative impact from their stuttering. Therefore, your SLP should create a comprehensive report, being sure to report all areas related to stuttering in the report and present a clear-cut diagnosis and treatment plan. Further, it is important that there be supporting evidence for the specific recommendations in the prescribed treatment plan.
Not all children who stutter are appropriate candidates for treatment. The child's level of motivation, parental commitment, child's cognitive status and other prognostic indicators should be considered when recommending treatment.