costs for speech therapy sessions

[larig]

:bag So, DH and I are doing insurance picking today (of course we wait until the last minute), and decided we needed to get a gauge on the cost of DS's speech therapy so we can set up $$ to go into our HSA. We've been going to the speech therapist for about 7 weeks. We haven't seen a bill yet. So, I thought I'd ask the therapist if she could tell us the cost. DS goes to an out-patient clinic affiliated with a hospital in our area. I was FLOORED when she came back after asking the billing people and said $340. DH and I are a one income family (granted he does make decent money), but that is just more than we can afford, especially when we are NOT sure that our insurance has covered it or will (given a claim has not come through, and given that they are not supposed to cover if it is not "medically necessary"). So, how does this rate compare. Is it what we should expect elsewhere (e.g. at private therapist's office)? Are there ways to save on this?

[justlearning]

The rates seem to really vary from one clinic to another and also depending on the exact services needed. For example, DS has motor issues with his tongue so they charge me twice the price due to billing it as both speech therapy and oral motor therapy or something like that (even though both are done in the same 30-minute session).

We have a high-deductible insurance, so everything up to $4K is out of our pocket. Thus, I asked about the cash-paying rate (not billed to the insurance, doesn't go towards my deductible). That was cheaper.

The rates that I've had to pay per session have been $80-$200 depending on whether they were charging me double and depending on the clinic.

[egoldber]

When older DD had speech therapy as a toddler it was $125 a session.

[megs4413]

That seems incredibly cheap to me if its their rate for 7 sessions without insurance paying a portion. I would expect at least $100/session before insurance.

[kijip]

Is it a double session or something?

That is just over twice what we pay here per week. It was a struggle but we pushed hard and got our insurance company to pay.

Oh wait. Is that $340 per session or for the 7 sessions? If it is for the 7 sessions that is a bargain. BIG bargain. Unless it is for 30 minutes and then that is about right, a little cheap.

[niccig]

We were paying private SLP for $75 for 30 mins cash. 30 mins is the face-time, the SLP is spending other time working on your child's file/prepping for sessions that's, and that's included in fee you pay.

It was up to you to claim on insurance. Many insurance companies will only cover if certain diagnosis. Eg. my speech therapy from surgery complications is covered, but DS's for articulation was not. You have to find out about your plan. And talk to SLP office, it all depends on codes they use.

How old is DS? EI is until 3 yrs of age, then it's school district if he qualifies.

My university department charges about $60 an hour as it's students giving therapy under supervision of a SLP. Parents come to us as school won't give services as child not severe enough to qualify or only give 1x30 mins session a week and parents want more. It's cheaper than private, but cons are that it's new student every semester and first few weeks are spent getting to know student and working out where to begin in therapy (we do have prior reports to read, but we still have to work out if continue previous goals or not).

[AnnieW625]

I was given a quote of $150-200 per session in 2008 for private speech therapy for DD1. Thankfully I think our insurance would have covered all but the $15 co pay, but thankfully they referred us to our local regional center and DD1 qualified until she was 3. Had she been over 3 she would have qualified for services through our school district. Have you checked to see if your school district might cover it?

[codex57]

Around here, it's roughly $100 per session (around 50 minutes).

[larig]

That seems incredibly cheap to me if its their rate for 7 sessions without insurance paying a portion. I would expect at least $100/session before insurance.

That's 340 per session.

He has an IEP, and gets 40 minutes through the school district. We are doing this to supplement. He is 4 but lags behind a great deal, and suspect he has hyperlexia (http://www.csld.org/Hyperlexia.htm). We have an appointment for an evaluation out-of-town with the person I've seen referred to as the nation's expert on hyperlexia, which gives me great hope (person who founded linked org). At this point DS needs help with language acquisition, but he can read and decode words that most second and third graders would be doing. He just can't converse, etc.

Eta: I'm not sure the current therapy is suited for a hyperlexic. I feel the SLP doesn't know what to do for him, in part because its a very rare disorder.

[Indianamom2]

When older DD had speech therapy as a toddler it was $125 a session.

That was about what we paid, although I think we got a bit of a discount.

Was the therapist saying it would be $340/session or that was the total bill so far? For how long per session?

[schrocat]

We're in the Seattle area and our private speech therapists charge $130 for a half hour session. Health insurance pays them $120 for half an hour.

I suspect that my older son might have had hyperlexia. He taught himself to read before he turned 3 and could read pretty much anything you put before him but he didn't talk and didn't converse with people.

[cuca_]

Are you sure it is not for the whole 7 weeks. I would call and ask again. We pay $50 per session (30 minutes). $340 per session sounds excessive by any standard. Even when we were in the NY area we never paid anything close to that amount.

[codex57]

That's 340 per session.

He has an IEP, and gets 40 minutes through the school district. We are doing this to supplement. He is 4 but lags behind a great deal, and suspect he has hyperlexia (http://www.csld.org/Hyperlexia.htm). We have an appointment for an evaluation out-of-town with the person I've seen referred to as the nation's expert on hyperlexia, which gives me great hope (person who founded linked org). At this point DS needs help with language acquisition, but he can read and decode words that most second and third graders would be doing. He just can't converse, etc.

Eta: I'm not sure the current therapy is suited for a hyperlexic. I feel the SLP doesn't know what to do for him, in part because its a very rare disorder.

Yeah, how long is the session. I mean, if it's for like 4 hours, well, it could be ok. If it's an hour or less, that's insane. Especially for the Land o Lincoln.

[hellokitty]

It's about $150 a session for a 30 min session. Thankfully, with our insurance, we owe $15 per session.

Does it matter if you are within network or not? We are going through pediatric therapy that is part of the same hospital system that dh works at. If we went elsewhere, we'd probably owe more. Luckily, I like our SLP, and am happy with their services.

[mytwosons]

Several years ago we paid $240 per 45-50 min session at a hospital clinic and $85 per hr at a private therapist working out of her home.

[larig]

That seems incredibly cheap to me if its their rate for 7 sessions without insurance paying a portion. I would expect at least $100/session before insurance.


Yeah, how long is the session. I mean, if it's for like 4 hours, well, it could be ok. If it's an hour or less, that's insane. Especially for the Land o Lincoln.

45 minute session. OT is almost $500.

[larig]

This is really helpful everyone. Gives me some perspective. This is outpatient therapy at a fancy rehab clinic affiliated with a hospital. They do cardiac rehab, etc there.

[ett]

45 minute session. OT is almost $500.

Oh wow. That's crazy. DS1's private OT was $110/hour. When we started it was $90/hour. I also called around to a couple of hospitals and their rates were all around the same.

[Seitvonzu]

the "self pay" rate for the place we go is $109, they charge insurance more i guess... the sessions are typically 40 minutes, then the SLP takes to me for about 5-10 minutes. we're currently going 2X a week and i'm about 75% the insurance is picking it up....that said, i really would like to see another explanation of benefits (beyond the evaluation , which they paid :))

[LMPC]

DD goes for a 30 min session and it's about $90. We pay 20% of that. But the place said that if our insurance didn't cover it, then they had a courtesy rate (which I'm assuming would be about the same as the allowable -- $90).

[mousemom]

Our speech therapist billed $180/hr. for private speech therapy. We're still fighting with our insurance about how much of that will be covered.

[kristac]

The rate around here seems to be $100-$150 a session. Our hippotherapist charges $115 for a half hour session- however if we pay out of pocket it would be $68 (which is the negotiated rate with insurance). DS has apraxia and so far we have not been successful in getting insurance to pay for any of his therapies. We are in the process of appealing.

[niccig]

Can you call around and see if anyone is cheaper. My COL is much higher than yours and we paid less at private clinic, but I know when my friend called a rehab clinic her insurance would cover, it was $280 an hour.

I'm wondering if that's the rate they charge the insurance company as know they'll only cover a percentage as the contracted rate. Happens with our drs. They bill health insurance company much more, Insurance says "our contracted rate is x" and our copy is percent of x amount, not the originally billed rate. You could ask what the cash rate is and then you claim with insurance later.

And once you see the expert, they may have a referral to a SLP.

[kijip]

I would definitely shop around a bit.

[mom2binsd]

Was that for the evaluation as those are more expensive. 340 is outrageous.

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[mom2binsd]

I wanted to add that most private slp's set their own rates, but most are in the 100.00-150.00range based on col etc. I'm currently at the annual speech language conference and I can tell you nobody here thought that was even possible.

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[larig]

Was that for the evaluation as those are more expensive. 340 is outrageous.

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No, unfortunately that was just one regular 45 minute session, not the evaluation. When I asked if that rate was for one session (because it seemed really high), the SLP said, "yeah, one session, sorry." Kind of like she knew it was high.

[larig]

We're in the Seattle area and our private speech therapists charge $130 for a half hour session. Health insurance pays them $120 for half an hour.

I suspect that my older son might have had hyperlexia. He taught himself to read before he turned 3 and could read pretty much anything you put before him but he didn't talk and didn't converse with people.

You are the first person I've had contact with who suspected hyperlexia in their child. For us, it was actually DS's SLP in the Seattle Public School's developmental preschool program right before we moved to IL, who first mentioned it to us. I had not heard of it. (She is my hero. I recently wrote to her to thank her for her insights. She was such a wonderful help to DS).

I called the organization that we'll be going to in Chicago to see what their costs are, but haven't heard back yet. They, however are a non-profit, so I'm guessing the costs will be lower, although they're in a much larger city (and have 2 offices--one in burbs one in Chicago).

The insurance piece is challenging to figure out, isn't it!? Ours says it doesn't pay unless medically necessary, and won't pay for developmental-delay related issues, but I would guess that some doctors can get around this somehow. The specialist we're seeing ONLY uses BCBS, so I assume they are good at knowing what to put on the forms to get therapy covered by them (and we happen to have them). I am hopeful that seeing them will open some new doors for us. The books we've gotten from them have already helped me with ideas for working at home and with understanding the quirks of hyperlexia.

[Seitvonzu]

larig-- we have BCBS as well. i know all plans are different (we're in maryland), but i thought i'd throw my 2 cents in since i spent TONS of time on the phone b/w them , the doctors office, the SLP office, etc.

they do say they will pay only if "medically necessary." they'll also tell you if you just call the general line "of course you'll have that paid, up to 75 sessions." *sigh* (they don't throw in the medically necessary unless you ask them over and over....) when i called billing directly a nice woman finally explained to me that they basically NEVER cover something under "developmental delay" because it's very vague. because it's "vague" it is an automatic red flag that has to be reviewed by a nurse/case manager and then ....they get denied. the billing person told me the "bad" code was anything with 315 (developmental delay).

after being evaluated the SLP was able to steer away from developmental delay to something else that insurance seems to like more (i say "seems" because they did cover our evaluation, we are still waiting on the appts and i'm being cautiously optimistic about them since the evaluation was put against our 75 "speech/ot/pt appts per calender year" and wasn't earmarked as "special")

good luck! it's definitely expensive out of pocket and it sounds like it's only one of the things your dealing with. i will say that in general i've found "centers" or ANYTHING attached to a hospital to be more $$$$. my endocronologist had 2 offices for a while and while she was covered 100% with a copay at one location, at the hospital's diabetes center they wanted something like $500 and it wasn't covered!!!! (that's no where near what my insurance pays her at her other location) i fought that and it got paid somehow (i'm sure they didn't get 500...) , but WHAT A SHOCK!

[larig]

larig-- we have BCBS as well. i know all plans are different (we're in maryland), but i thought i'd throw my 2 cents in since i spent TONS of time on the phone b/w them , the doctors office, the SLP office, etc.

they do say they will pay only if "medically necessary." they'll also tell you if you just call the general line "of course you'll have that paid, up to 75 sessions." *sigh* (they don't throw in the medically necessary unless you ask them over and over....) when i called billing directly a nice woman finally explained to me that they basically NEVER cover something under "developmental delay" because it's very vague. because it's "vague" it is an automatic red flag that has to be reviewed by a nurse/case manager and then ....they get denied. the billing person told me the "bad" code was anything with 315 (developmental delay).

after being evaluated the SLP was able to steer away from developmental delay to something else that insurance seems to like more (i say "seems" because they did cover our evaluation, we are still waiting on the appts and i'm being cautiously optimistic about them since the evaluation was put against our 75 "speech/ot/pt appts per calender year" and wasn't earmarked as "special")

good luck! it's definitely expensive out of pocket and it sounds like it's only one of the things your dealing with. i will say that in general i've found "centers" or ANYTHING attached to a hospital to be more $$$$. my endocronologist had 2 offices for a while and while she was covered 100% with a copay at one location, at the hospital's diabetes center they wanted something like $500 and it wasn't covered!!!! (that's no where near what my insurance pays her at her other location) i fought that and it got paid somehow (i'm sure they didn't get 500...) , but WHAT A SHOCK!

This is SO helpful, thanks for taking the time to write such a lengthy and informative response. I have such anxiety about dealing with insurance companies, because I just haven't had to thus far (knock on wood). Nice to have some help before I wade into this process.

Here is what our current policy says about the SLP and OT visits.


Limited to 50 visits (in outpatient or office setting) paid by the plan per plan year for physical and occupational therapy combined unless additional visits are deemed medically necessary.

Limited to 25 visits (in outpatient or office setting) paid by the plan per plan year for speech therapy unless additional visits are deemed medically necessary.

No coverage for services primarily educational in nature, vocational rehabilitation, developmental delay services, self-care and self-help training (non-medical), health clubs and spas, learning disabilities and disorders, and recreational therapy or for services not expected to make measurable or sustainable improvement within a reasonable amount of time.

The odd thing is that is says we should seek prior authorization only for speech therapy AFTER the intial 25 visits.

Prior Authorization*
Prior to receiving certain services, it is recommended that you contact BCBS for prior authorization to make sure the services are medically necessary before you or a covered dependent receives them. Verify with your provider if this is a service they will perform for you or if you will need to complete the prior authorization request. When you request prior authorization, BCBS will determine whether the services are medically necessary, appropriate, and eligible under the terms of your contract. If the services are determined to be cosmetic or otherwise not medically necessary, the services would not be covered and will be your responsibility. The services for which a prior authorization is recommended are:
...
Speech therapy (visits beyond the plan’s annual 25 visit maximum)

It's a little contradictory. It's like saying, you get 25 visits, but then the next 25 only if they're medically necessary, but in the other place it says they won't cover anything related to dev. delays, etc. It is just so very confusing. We don't have an official diagnosis of anything yet, but we have a very accommodating ped, who I am sure will be willing to help us get the therapy we need, as he had recommended we continue with it.

[Seitvonzu]

awesome that i could help.

a couple other things that came up for us:

1. we needed a "script" from the ped in order to get the SLP to see us. this wasn't related to insurance, but to the SLP's licensing. however...the script should NOT have a diagnosis code on it!!!!! our ped. put a 315 diagnosis and this was a huge huge issue because the SLP couldn't change what the ped put, even AFTER their evaluation.

however, if the ped doesn't put anything...the SLP can put their own code. Crazy!

so we had to have the ped basically "cross out" the code. although this was kosher, it caused headaches and lots of running around/phone calls.

2. the billing dept at BCBS told me to ask about a specific code-- 740? (it was definitely in the 700s...) this one is NOT a red flag like 315. and according to our SLP it's appropriate in lots of cases where 315 doesn't work. i think it's something like "speech disturbance"


i was very wary of mentioning these things to the SLP because i was worried that somehow talking about codes/diagnosis was going to get someone "in trouble." obviously i wanted my child to get the services she needs (it's very hard to understand her even though she's extremely bright...i was afraid that starting school next year these issues might cause her to slip through the cracks and become a behavior issue). and of course i wanted my insurance to pay if it was covered...but i didn't want anyone to say untrue things to get it covered-- know what i mean?

it seems like already having the school services should HELP you get services covered. from our evaluation, my daughter wouldn't be eligible for public services (but believe me, she does need the therapy!)

[zag95]

I would shop around. Is there someone that could be recommended??

Our speech sessions are about 140 per session. We pay the 10 copay. We get 30 visits per calendar yr. Last fall, we ran out of visits (had used up our visits) and had to pay out of pocket- we spent about $1000 on speech for a couple of mos prior to Christmas (ouch!). We also appealed to our insurance (we have BCBS thru hubby's work) for additional sessions (DD was born with bilateral cleft lip and palate and needs these!) and were denied.

I would check with any graduate school programs that do speech and have a clinic. Services are usually supervised by a speech path.

See what early intervention/services your DS qualifies for with public school. DD has been doing EI (early intervention) since she was 2- she's almost 5. We have been getting one small group speech session per week, plus our private speech I mentioned above.

Contact the children's hospital and see who they might recommend, other than the clinic you go to, and then price shop.

Shriners might be an option, as well as Scottish Rite, as they do things with speech therapy.
GL!

[niccig]

It's a little contradictory. It's like saying, you get 25 visits, but then the next 25 only if they're medically necessary, but in the other place it says they won't cover anything related to dev. delays, etc. It is just so very confusing. We don't have an official diagnosis of anything yet, but we have a very accommodating ped, who I am sure will be willing to help us get the therapy we need, as he had recommended we continue with it.

I think this is the difference between medically necessary and developmental.

You get 25 if there's a physical medical reason (cleft palate, paralyzed vocal fold, swallowing issues) and then if you need more, the SLP/Dr has to explain why 25 more are needed, but again it has to be medically related.

Developmental reasons are often not covered.

As a pper said, it comes down to evaluation and the codes used.

[egoldber]

:yeahthat:

Our insurance (BCBS at the time) covered nothing because it was for developmental delay and not a medical issue. I think it is common for insurance to say they will cover X visits, then need an assessment from a physician that additional therapy is still needed and often that there will be improvement. Insurance also often does not pay to maintain, only to improve.

[kijip]

Our insurance did not cover it when it was billed as developmental but once they paired it with the code for his HFA, they covered it. He was diagnosed before the first speech visit but the SLP office did not reflect that in their billing. My husband had to look up the codes at work and tell them what to use. If your son has a diagnosis, that may change your insurance coverage.