The Price is Right
Updated: Dec 3, 2022
How to Choose Your Speech Language Pathologist (SLP): Price
Part 4 in our ongoing series How to Choose Your SLP.
Welcome back from the holiday weekend! We hope you had a wonderful break no matter what you did.
So far, you've learned about Setting, Location, and Philosophy -- three of our six key factors for choosing an SLP who will be the best fit for your child. If you haven't read those yet, check out the links above to see our related posts!
Now, we will delve into our fourth factor: PRICE
While Early Intervention and Public School services are free, private practices or outpatient hospital settings may have different options for payment.
One of the first things parents ask me about is price -- and as a parent myself, I get it! Insurance is absurdly complicated and opaque making it much more difficult to understand what the actual costs will be for your family.
Read on to learn all of the juicy details -- I promise you, it will make sense!
Some practices might be in-network for your insurance. This means you will pay a copay for each visit based on your plan.
Outpatient clinics, since they are affiliated with larger hospitals, tend to take multiple insurance providers. They have a team of administrators that negotiate with insurance companies and file paperwork.
Private practices may take insurance but it can be difficult for smaller practices who have to spend time filing paperwork or arguing with insurance companies over claims. In addition, many insurance companies reimburse providers poorly, which can be difficult for new or small businesses.
In-network providers have to follow the regulations demanded by insurance companies. Insurances will require a diagnosis and proof of medical necessity -- essentially determining that your child needs speech therapy. This means providers must evaluate your child's skills (often focusing on deficits rather than strengths) and must provide support that therapy is needed (often in the form of standardized scores and descriptions of how your child is "below average").
Some insurances will deny claims if scores are not low enough or if they believe that treatment is elective rather than medically-necessary (e.g., speech sounds/accent modification). Some insurance companies may also deny claims for school-age children saying that they should be receiving services within the school system (even though children only qualify for services in their school if it is impacting them academically).
Despite these challenges, finding an in-network provider can make therapy services affordable for families, especially if your child will benefit from multiple sessions per week. Because they are highly sought after, therapists who do take insurance often have a waitlist for services so be sure to ask if a clinician is currently taking new clients.
Other practices will be out-of-network for your insurance. In this case, you will pay the full session rate each week. Private pay clinics will then provide you a superbill for you to submit to insurances for reimbursement. (This is what Talk Time does!)
A superbill is an itemized form used by healthcare providers which details services provided to a patient. It is given to patients to submit for reimbursement and is the main data source for creating a healthcare claim with insurance providers.
Every insurance plan and each child’s diagnosis is unique, therefore, the process may vary slightly from plan-to-plan. For this reason, we encourage all our new patients to use the number on the back of their insurance card to call their provider directly and determine the reimbursement specifics for their particular plan.
These are some of questions we recommend clients ask their insurance provider:
What are my speech therapy benefits in my plan?
What is the coverage for an "out-of-network provider"
What percentage of the treatment will be covered?
How many visits are covered?
Exactly what information should accompany insurance claims?
Do I need pre-approval or a referral before we start?
While the cost for families is higher up front, many receive reimbursements back from their insurance providers that make the total cost for therapy equivalent to a copay of anywhere from $20-$50 a session.
From a clinician's perspective, there are so many benefits to using a private pay model. It is both extremely difficult and time-consuming to take insurance. Often, it involves a lot of additional paperwork and extra phone calls to check in on reimbursements. Private pay allows clinicians to use the time without clients to prep treatment sessions, facilitate home carryover, meet with caregivers, collaborate with other providers on their client's team, and create free informative content for families.
In addition, clinicians who take private pay do not have to follow regulations dictated by the insurance company. They do not have to prove medical necessity and can provide evaluations that are more strengths-based, qualitative, or dynamic in nature so capture the child's abilities rather than focusing on their deficits and labeling their disorder for insurance.
But even with superbill reimbursements from insurance, we know that it is sometimes still too much for families. Their child might not be able to receive the correct frequency of services or might not be able to receive services at all if the only option is a private pay clinic.
Talk Time Boston is committed to providing accessible services for families. This is why we have decided to pilot a sliding scale payment model starting in January 2023.