Out-Of-Network Benefits Guide

​

Using your out-of-network benefits is often easier than you may realize!

 

This guide will assist you as you contact your insurance company to determine their process for filing out-of-network benefits. It should also help you determine if speech and feeding therapy benefits are included in your policy as well as how to submit a claim for potential reimbursement for the services you have already paid for.

Little Palm Speech & Feeding Therapy cannot guarantee out-of-network reimbursement, and it is the family’s responsibility to speak with their insurance provider to understand their benefits.

 

 1. Call the member services phone number on the back of your insurance card.

 2. Tell the customer service representative you would like information about your coverage for Speech Therapy benefits with an out-of-network provider.

  • Document your conversation:

    • Name of customer service representative

    • Date of call

    • Time of call

 3. Have the following information ready & available in the event they need it:           

  • Insured’s Name

  • Patient’s Name

  • Date of Birth

  • Insurance Member ID

  • Policy/Group Number

  • Provider’s Name

    • SLP State License #

    • ASHA Certification #

    • NPI Number #

*provider details will be provided via email upon request

 4. Ask these questions when speaking to the customer service representative:

  1. What is my coverage for speech therapy benefits?

  2. Do I need pre-authorization for speech therapy? If so, how do I obtain it?

  3. Can I submit a SuperBill?

  4. What is the process for filing a claim after I have a SuperBill for services?

  5. What additional forms do I need to submit when filing my claim?

  6. Where can I find the forms on your website? Can you email me a copy?

  7. Can I file my claim online or do I need to mail/fax it to you?

  8. Do I need to file my claim within a certain amount of time after the date of service?

  9. How long does it take to process my claim?

  10. Can I appeal if a claim is denied?

Your insurance company may request which charge codes (CPT) & diagnosis codes will be used. We are unable to provide diagnosis codes until an evaluation has been completed.

 CPT Codes:

  • Speech and Language Evaluations: 92523

  • Speech and Language Treatment: 92507

  • Clinical Evaluation of Swallowing and Feeding: 92610

  • Treatment of Swallowing Dysfunction and/or Oral Function: 92526

    ​

Submitting Claims

  • Most insurance companies allow you to upload a SuperBill (receipt provided at the end of the session with codes) on their web portal.

  • There is also an app called Reimbursify that streamlines this process.