Does Insurance Cover Dyslexia Therapy?
Digging through your schedule of benefits. Combing through the lists of exclusions. Determining your deductible and copays and coinsurance. Getting fed up and then spending an hour on the phone with an insurance rep…
All of this just to find out...does my insurance cover dyslexia therapy!?
The short answer is—depends! Coverage varies based on your individual insurance plan, what diagnosis you have, where the services are provided, among others. An exclusion for certain codes, including dyslexia, are also common.
However, determining whether dyslexia therapy is included in your benefits is worth pursuing. Dyslexia is a persistent disorder and may require years of therapy. If you have speech therapy coverage and a dyslexia diagnosis is not excluded, seeing an in-network speech therapist could save you a lot of money.
Also, knowing your coverage before you start searching for a dyslexia provider may influence who you select to treat your child’s dyslexia. More on that at the end of this post...
Private practice speech therapists in our Collective report that:
some clients receive 100% coverage and pay $0
others pay a $5 to $15 copay/co-insurance
and, still, some other clients do not have speech therapy benefits at all
Seeing an in-network provider when you do not have speech therapy benefits still may be worthwhile. Since the provider is in-network, that guarantees you their contracted rate. The contracted rate most often means you will pay less than the speech therapist’s regular rate.
How do I figure out if my insurance company covers dyslexia therapy?
First, you need to determine if speech therapy is covered at all and what benefits you have. To find out, call the customer service number on the back of your insurance card. Ask if your insurance plan covers a speech therapy evaluation (CPT codes 92521, 92522, 92523) and speech therapy treatment (CPT codes 92507 and 92508).
If yes, you will at least be eligible for the contracted service rate. This rate is almost always lower than the private pay rate at your speech therapist’s office. The fees you pay for services will count towards your child’s deductible.
Second, you need to determine if dyslexia is covered or if it is an excluded diagnosis. Some insurance plans exclude an entire class of codes related to developmental disorders, which often includes dyslexia.
Keep in mind that the word “Dyslexia” means something different in the health insurance world. It means a form of dyslexia that occurs due to a head/brain injury or stroke. Sometimes plans cover this type of dyslexia but not the type occurring in children, so you want to be specific when you call!
You want to ask about developmental dyslexia. In insurance language, this type of dyslexia is referred to as a Specific Reading Disorder (diagnostic code F81.0). Developmental dyslexia does not only apply to children with dyslexia.
Adults with dyslexia can also be diagnosed with developmental dyslexia. The word developmental simply means that the dyslexia initially developed during childhood.
If dyslexia is excluded, finding a speech therapist who is in-network with your plan is unnecessary. You won’t be eligible for their lower contracted rate even if they are an in-network provider. You then have more freedom in searching our database for a talented speech therapist specializing in dyslexia. You can consider both in- and out-of-network speech therapists.
And third, you also want to inquire whether your insurance plan covers speech therapy conducted via teletherapy (i.e., video sessions) or only in-person sessions. Coverage also varies based on the place of service--inpatient hospital, outpatient hospital, office visit (which usually covers private practice), in-home, teletherapy, school, etc.
If your speech therapist is in-network with your insurance plan, they actually have access to this information once they have your insurance member ID number. Best practice is that they call and verify this information prior to your initial evaluation or first therapy session. As an in-network provider, they should be able to help you understand your coverage.
If the speech therapist can figure this out, why should I call the insurance company in the first place?
Being an informed healthcare consumer includes understanding your insurance coverage. If you can save a significant amount of money seeing an in-network speech therapist, then seeing an in-network provider makes the most sense.
However, a fair number of talented speech therapists do not accept health insurance, and dyslexia testing and dyslexia therapy requires expertise. That is, just because a speech therapist is in-network does not mean they will be the best fit for your child’s dyslexia needs.
Further, many large-scale clinics place incoming clients with the first available speech therapist rather than placing the client with the best fitting speech therapist. Many large-scale clinics accept many insurance plans, which is appealing for healthcare consumers. However, you wouldn’t see a cardiologist for a lung problem and you wouldn’t seen an optometrist for a foot problem.
You and your child deserve to work with a speech therapist who is highly-trained for your specific area of need. This person may or may not accept your particular insurance plan. Understanding your health insurance benefits and coverage will help you determine whether an in-network provider is worthwhile. Or, alternatively, whether you should broaden your scope to speech therapists outside your health insurance network.
Once you know your insurance coverage...
Search the speech therapist directory at Choice Therapy Collective. You can find the best speech therapist to fit your needs based on accepted insurances (if that is a consideration of yours), geographic region, and expertise.
We are here to help you make informed decisions about your and/or your child’s healthcare. Insurance is an important piece of the puzzle, but not the only piece. Understanding what your speech therapy coverage is will guide you when deciding on your new speech therapist.