INSURANCE
Currently IN network with the following commercial insurance plans:
-
Aetna
-
BCBS
-
Blue Advantage​
-
Blue Care
-
Blue Options
-
Blue Value
-
Classic Blue
-
NC State Health Plan
**Not in network with Local plans
-
-
Cigna (managed by RPN)
-
UnitedHealthcare (Optum)
Currently IN network with the following government funded insurance plans:
-
Alliance
-
AmeriHealth Caritas
-
Carolina Complete
-
Healthy Blue
-
Medicare
-
NC Medicaid FFS Direct
-
Trillium
-
UnitedHealthcare Community Plan
-
Wellcare
-
SC Medicaid (Direct only **NOT in network with SC Managed Care Plans)
*Please call the number on the back of your insurance card to verify that Euphony Speech is IN network for your specific plan. The codes billed for the evaluation are 92610 and 92522. The treatment codes for regular therapy are 92526 and 92507.
​
All other insurance plans are considered OUT of network. A superbill is available upon request for you to submit to your individual insurance. We may electronically submit a claim to some out of network insurances as a courtesy. Please call your insurance to inquire about your specific plans' out of network benefits.
​​
INSURANCE TALKING POINTS: Questions to Ask Regarding Coverage
Be sure to record the following information and maintain for you records in case an appeal is needed later.
Representative's Name: ______________Reference Number: _____________________Date: _________
Euphony Speech NPI is 1063051670. EIN/TIN 83-4462721**. Molly Vaccaro NPI 1528471067.
**For Cigna, you need to provide RPN TIN: 11-3670557 instead of EIN 83-4462721
Q 1: Client is ____ years old. Is speech therapy covered?
A 1:_________________________________________________________________________
Q 2: Are these ICD-10 codes below covered in conjunction with treatment code 92526?
A 2: R13.11 Yes â—½ Noâ—½ R13.12 Yes â—½ Noâ—½ R63.32 Yes â—½ Noâ—½ M25.69 Yes â—½ Noâ—½
Q 3: Are these ICD-10 codes below covered in conjunction with treatment code 92507?
A 3: F80.0 Yes â—½ Noâ—½ F80.1 Yes â—½ Noâ—½ R47.89 Yes â—½ Noâ—½
Q 4: What is my cost participation for in-office/private clinic speech therapy visits?
A 4: Deductible? _____________ Co-Payment?_______________ Co-Insurance?___________ Session maximum? _______________
Q 5: How many habilitative visits are covered? How many rehabilitative visits are covered?
A 5: Habilitative _____________ Rehabilitative _____________
Q 6: Is there a hard limit on the number of visits allowed? If yes, what is needed to request additional visits?
A 6:__________________________________________________________________________
Q 7: Is a pre-certification or pre-authorization required prior to the start of therapy? If yes, what is fax submission phone #?
A 7:__________________________________________________________________________
Q 8: Are there conditions that are specifically excluded from treatment?
A 8: _________________________________________________________________________
Q 9: Is this plan considered an Affordable Care Act plan?
A 9:__________________________________________________________________________
Q 10: Are the evaluation codes 92610 and 92522 covered? If yes, can 92610 and 92522 be billed the same day?
A 10:________________________________________________________________________
Q 11: Can 92526 and 92507 be billed the same day?
A 11:_________________________________________________________________________
Q 12: Is there a global reimbursement rate per day?
A 12: _______________________________________________________________________
​
For OUT of network providers, also ask:
Q 13: Are out of network providers covered as part of my plan? At what amount?
A 13: _______________________________________________________________________
​
ADDITIONAL NOTES:
More info on what these questions mean:
1. What diagnosis (ICD-10) and treatment (CPT) codes are covered for reimbursement?
There are a variety of different diagnosis and treatment codes that could be applicable to your speech therapy coverage. It’s important to speak to your speech-language pathologist (SLP) to determine which codes apply to you.
2. What codes and/or conditions are excluded from my coverage?
As mentioned above, not all speech therapy coverage is created equal. Unfortunately, many insurance plans exclude different codes or conditions from coverage. This means that even if you choose to use a SLP or clinic/company that accepts your insurance, your services may still not be covered. In many cases, insurance companies exclude “developmental” speech therapy services. These types of services typically apply to children who are “late talkers” or have a “speech delay” or “language delay.”
3. What conditions are covered?
As important as it is to find out what conditions and codes are excluded from your coverage, it’s equally important to verify what conditions are covered.
4. Do I need a prescription to obtain speech therapy coverage?
Some insurance plans require your doctor to write an order for speech therapy. If you need an order, but don’t obtain one prior to starting therapy, the services will likely not be covered. We will request for you if you inform us.
5. Do I need a pre-certification or prior authorization for speech therapy coverage?
Your plan may require pre-certification or prior authorization for speech therapy coverage. This is a process in which you need to be pre-approved for the services in question. If your insurance company does require it, it’s important to ask what the pre-certification/prior authorization requirements are and then we can assist you with obtaining the prior authorization.
6. Are out-of-network speech therapy services covered?
There are many instances where you may choose to use an SLP for speech therapy services that does not accept insurance or is not in your plan. You may choose to do this due to the SLP’s reputation, expertise, and/or proximity to your home. If you are looking to pay for services with your insurance, it’s crucial that you confirm if out-of-network benefits are covered prior to initiating services with an out-of-network SLP. However, if you are not worried about seeking reimbursement, you may begin services without contacting your insurance company.
7. Do I have a deductible, copay or coinsurance?
Even if speech therapy, and the specific codes/conditions described above, are covered, you may be responsible for a deductible, copay, and/or coinsurance. If you are responsible for any one of these expenses, an important follow up question would be specifically how much you are required to pay.
8. Can I be reimbursed for out-of-pocket speech therapy expenses?
If you can receive reimbursement for out-of-pocket speech therapy expenses, there are additional questions you should ask. For example, what is the reimbursement rate? You should also find out what you need to do and/or submit to obtain reimbursement.
9. How many speech therapy sessions are covered per calendar year?
Did you know that many insurance plans have a limit on how many therapy sessions a person can receive per calendar year? It’s important to find out if this is applicable to your plan. Some plans restrict patients to 30 or 60 therapy visits during a calendar year. Many plans that have this restriction often lump speech therapy, physical therapy, and occupational therapy together in those 60 visits to it is important to inform us if you or your child are seeing multiple therapists that are billing your insurance.