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Therapy Source Career Center - June 2019

Insurance Reimbursement in Stuttering: Notes for the consumer

Insurance Reimbursement in Stuttering: Notes for the consumer
Craig Coleman, MA, CCC-SLP
November 21, 2005



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.

Step One:

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.

Step Two:

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.


craig coleman

Craig Coleman, MA, CCC-SLP

Related Courses

The Ripple Effect of Stuttering: A Community-Based Approach
Presented by Craig Coleman, MA, CCC-SLP, BCS-F, ASHA Fellow, Mary Weidner, PhD, CCC-SLP
Course: #9217Level: Intermediate2 Hours
This is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)

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This course is Part 4 in a four-part series. It will provide an overview of stuttering peer support communities and the clinical importance of incorporating community experience into therapy. Current research and practical application questions will address goal writing, SLP roles and responsibilities, and common challenges connecting therapy to the community. Case studies will be shared to highlight assessment and treatment across various age ranges. (Part 1 - Course 9278, Part 2 - Course 9286, Part 3 - Course 9301)

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This course will review scenarios that might result in difficult discussions with parents and children in stuttering assessment and treatment. Strategies for building effective therapeutic partnerships will be discussed.

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This is Part 1 of a four-part series. This course will cover current research and trends in stuttering. Specifically, information related to risk factors and epidemiology, as well as the foundational knowledge needed to assess and treat stuttering, will be addressed. Additionally, assessment of people who stutter will be described through the International Classification of Functioning, Disability and Health (ICF) model, which focuses on all aspects of stuttering, beyond the surface-level characteristics. (Part 2 - Course 9286, Part 3 - Course 9301, Part 4 - Course 9304)

ApPARENTly This Is Not Going Well: Difficult Conversations with Parents
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This course explores emotional intelligence (EQ) and how to "plug in" and use it in situations that go awry with parents of clients. Specific strategies for handling difficult situations and de-escalating arguments are discussed.