Tuesday, November 28, 2023

Does Blue Cross Blue Shield Cover Speech Therapy

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How Much Does Couples Therapy Cost Without Insurance

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The cost of couples therapy varies depending on the clinicians skill level, location, and training.

Therapists who are well-known and regarded usually charge more. Residents of high-income or high-cost-of-living areas might expect to pay higher rates.7

Most couples pay $75-$200 per hour without insurance. Some therapists charge on a sliding scale based on income or offer savings if you purchase multiple sessions. Couples counseling without insurance can quickly add up because most couples see their therapist weekly.

Here Are Some Question To Ask Of Your Insurance Carrier:

  • Do I need a prescription or referral?
  • Do I need prior authorization or pre-certification? You or the provider may need to call in advance of starting sessions to obtain approval.
  • Is there coverage for both assessment and treatment Does my plan provide coverage for my childs speech therapy?
  • How many visits are allowed within a calendar year under my insurance plan?

Are there any exclusions or limitations to therapy coverage? Is coverage limited to conditions that are acquired, restorative or rehabilitative which typically excludes coverage for services for children classified as developmental or educational. If relevant to your child ask if there is coverage for:

  • Developmental disabilities such as: Autism, Cerebral Palsy, Down Syndrome
  • Specific diagnostic categories such as: treatment for Voice and/or Stuttering Disorders
  • Do I have a deductible, co-pay or coinsurance?
  • Is there coverage if I use a provider who is out of network?

What Is Couples Counseling

Couples counseling is a type of psychotherapy that can aid in the improvement of your relationship with your partner. Suppose youre experiencing marital or relationship issues or want to enhance your bond. In that case, couples counseling may be able to help rebuild your connection and strengthen the relationship.1

There are many different types of couples counseling, including marriage therapy and the following therapy treatment and techniques:2

  • Reflective Listening
  • Imago relationship therapy

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Benefits Of Blue Cross’s Behavioral Therapy Coverage

Here are some common autism benefits covered by Blue Cross:

  • Applied Behavior Analysis therapy
  • Occupational, speech, and physical therapy
  • Nutritional counseling
  • Some treatment for autism could be fully or partially covered by Blue Cross depending on your individual plan.

    Some employers are able to personalize the programs they provide, and they could alter which benefits are included in your insurance plan.

    The most important thing your family could do before receiving treatment services is to check your insurance coverage.

    ABA therapy is costly if paid out-of-pocket, so make sure to confirm with your insurance provider that they can cover costs either partially or fully.

    Blue Cross needs to receive a request from members which is sent by the ABA therapy provider. In the pre-authorization procedure, the first step will be to confirm if:

  • The provider is qualified to provide ABA therapy.
  • The member has ABA therapy coverage.
  • The initial therapy plan meets is medically necessary for the child.
  • The member has been diagnosed with autism by a certified diagnostician.
  • Application And Appeal Of Primary Coverage Criteria

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  • The following rules apply to any application of the Primary Coverage Criteria. Health Advantage shall have full discretion in applying the Primary Coverage Criteria, and in interpreting any of its terms or phrases, or the manner in which it shall apply to a given intervention. No intervention shall be deemed to meet the Primary Coverage Criteria unless the intervention qualifies underall of the following rules:
  • Illegality: An intervention does not meet the Primary Coverage Criteria if it is illegal to administer or receive it under federal laws or regulations or the law or regulations of the state where administered.
  • Proper License: An intervention does not meet the Primary Coverage Criteria if the health-care professional or facility administering it does not hold the proper license, permit, accreditation or other regulatory approval required under applicable laws or regulations in order to administer the intervention.
  • Plan Exclusions, Limitations or Eligibility Standards: Even if an intervention otherwise meets the Primary Coverage Criteria, it is not covered under the member’s health plan or policy if the intervention is subject to a Plan exclusion or limitation, or if a member fails to meet eligibility requirements.
  • Members may appeal a determination by Health Advantage that an intervention does not meet the Primary Coverage Criteria to the Appeals Coordinator using the procedures for appeals outlined in the member’s policy or certificate.
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    Would Insurance Plans Help With Speech Therapy Coverage

    Usually, families need a doctors help to be able to access and receive the benefits of insurance plans for speech therapy services. Even though you realize that your child needs help, and the teacher of your child thinks the same way, a diagnosis by a doctor is required for your child, which implies that your child needs speech therapy. This could be achieved via a written-out prescription received by your doctor so that your child could start seeing a speech therapist.

    Thank You For Your Hard Work And Dedication To These Kiddos

    “I took my 2-year-old son to Speech Source for his issue with articulation, and Kimberly was our therapist. We had a wonderful experience with her. She developed a quick bond with our son and helped him come a long way with his articulation. She also was very helpful in explaining the process to me, so I could practice with him at home. My son adored Kimberly, and I would highly recommend her to anyone seeking speech therapy for themselves or their child.

    Speech Source is also a very well-equipped facility with lots of great toys, books and activities that engage children and help them get excited about the process.”

    – Cynthia L., Los Angeles, CA

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    How Much Supplementary Health Or Dental Insurance Do You Need

    There are a wide variety of supplementary health and dental insurance plans, each with their own level of coverage, but the amount of health insurance you need is a highly personal decision. Only you can decide how much is right for you, but an insurance agent or company may be able to help you make those decisions. Visit the finding an insurance agent or company section of Working With an Insurance Agent or Company to find someone who can help you.

    Factors to consider when deciding how much coverage you need include:

    • How much can you afford to pay each month? Each year?
    • Supplementary Health and Dental Insurance | 101: Getting Started 4

    • Do you have any other supplementary health insurance through your employer, a parents group plan or a spouse/partner?
    • Do you require prescription drugs on an ongoing basis?
    • Are you willing to share a hospital room, or do you prefer a private room?
    • Do you wear glasses or contact lenses?
    • Do you receive medical services from professionals such as chiropractors or massage therapists?
    • Can you afford to pay out of pocket for ambulance fees?
    • Do you have a chronic illness that requires more extensive medical services than OHIP provides?
    • Do you have a pre-existing medical condition? Some supplementary health insurance plans do not cover this. Be sure to shop around to find an insurer who might.

    A Federal Program: Medicaid

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    Medicaid is the social security run by federal authorities, and its purpose is to help people who seek health care but are unable to afford it. To benefit from Medicaid, you or your family have to meet the financial benchmarks that have been set by the authorities. If you fail to meet these requirements, you might be expected to provide evidence of the family member with disabilities which makes them eligible for Medicaid. Medicaid considers autism a disability, and if the family member with disabilities is deemed qualified, then the person with the disability can receive the help and treatment that they need. Contrary to the popular belief, Medicaid is still considered high coverage insurance by professionals. Usually, each state pays for the services received by the people via Medicaid and is qualified for it. Parts of the population that the states are obliged to cover:

    • Children coming from low-income families aged up to 18
    • Pregnant women coming from low-income families
    • Caretakers or parents from low-income families
    • People or seniors with disabilities getting cash benefits from the supplemental security income program

    Unfortunately, Medicaid healthcare plans are not accepted by all hospitals and healthcare centers. If you choose to see a doctor that is not included in the network provided by Medicaid, then you may be required to pay some or all of the expenses. Fortunately, various types of autism treatments are covered in Medicaid plans, and these treatments include:

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    Do I Need To See My Doctor Before Visiting A Blue Cross Blue Shield Therapist

    If you need to see your primary care doctor before visiting a Blue Cross Blue Shield therapist depends on your insurance plan type:

    • HMO or POS plan: Yes, you are typically required to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services
    • PPO or EPO plan: No, you typically dont need to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services.

    This referral requirement is also called pre-authorization . Pre-authorization is a process where a health provider, in this case your therapist, must get approval from your insurance company before providing you with care in order for the services to be covered. Your Summary of Benefits should indicate whether you need pre-authorization for outpatient mental health services.

    Note: While Blue Cross and Blue Shield is often referenced as one entity, The Blue Cross and Blue Shield Association is in fact composed of 36 locally operated companies. While the following guide provides an overview of Blue Cross Blue Shield therapy coverage, its important to check your specific plan, as each regional affiliate, and within those, each plan, has a unique level of coverage.

    Find therapists in-network with Blue Cross Blue Shield

    Purpose And Effect Of Primary Coverage Criteria

    The Primary Coverage Criteria are designed to allow Plan benefits for only those health interventions that are proven as safe and effective treatment. Members will receive an Explanation of Benefits , and Providers will receive an Explanation of Payment with claims processing remarks that indicate that a claim was not eligible for benefits since the Primary Coverage Criteria was not met.

    Another goal of the Primary Coverage Criteria is to provide benefits only for the less invasive or less risky intervention when such intervention would safely and effectively treat the medical condition or to provide benefits for treatment in an outpatient, doctor’s office or home-care setting when such treatment would be a safe and effective alternative to hospitalization. Examples of the types of health interventions that the Primary Coverage Criteria exclude from coverage include such things as the cost of a hospitalization for a minor cold or some other condition that could be treated outside the hospital or the cost of some investigational drug or treatment, such as herbal therapy or some forms of high-dose chemotherapy not shown to have any beneficial or curative effect on a particular cancerous condition.

    Finally, the Primary Coverage Criteria require that if there are two or more effective alternative health interventions, the member’s health plan or policy should limit its payment to the Allowable Charge for the most cost-effective intervention.

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    Coverage Policy: Primary Coverage Criteria

    The Primary Coverage Criteria apply toall benefits a member may claim under a health plan or policy, no matter what types of health intervention may be involved or when or where the intervention is obtained.Health Intervention orIntervention means an item or service delivered or undertaken primarily to:

    • Diagnose, detect, treat, palliate or alleviate a medical condition or
    • Maintain or restore functional ability of the mind or body.

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    There Are 3 Options For Payment Of Your Childs Therapy:

    Pediatric Speech and Language Specialists is a Participating Provider with the following insurance carriers:

    • Blue Cross / Blue Shield

    In network refers to insurance companies with whom are participating providers. Please read your benefits plan carefully. We encourage you to call your insurance carriers Member Services line to verify your plans coverage for your childs needs.

    If you are enrolled in a managed care group, such as an HMO or PPO, you might need a referral from your primary care physician. Please contact your physician for a prescription for service, including any diagnosis your child may have, before your appointment.

    As a courtesy to our patients, we will obtain your benefit information from your insurance carrier prior to your first visit- only if we have your insurance card prior to your visit. If you do not send your insurance card in prior to your visit, we will call for your benefits after we get your insurance information.

    Although we have verified your benefit, this is never a guarantee of payment. Limits of contracted coverage can vary widely depending upon the type of plan and levels of coverage selected. At times what is stated via the telephone prior to the evaluation in regard to benefits may vary when they see your childs diagnostic codes after the evaluation. Some or all of the services provided in your treatment may be not covered services under your particular plan, and these charges are your responsibility.

    How Do I Check If My Blue Cross Blue Shield Plan Covers Therapy

    To check whether your Blue Cross Blue Shield plan covers therapy, look for the Outpatient Mental Health line item on your Summary of Benefits. Therapy is considered a type of outpatient mental health service. You can find your Summary of Benefits by logging into your Blue Cross Blue Shield Member Services portal , calling member services, or checking your employers benefits portal.

    Here is an example of what your Blue Cross Blue Shield Summary of Benefits may look like, and where to find the Outpatient Mental Health line item:

    If the Outpatient Mental Health line item indicates that these services are not covered, then your health insurance plan does not cover therapy services.

    If you cannot find coverage information for Outpatient Mental Health, contact your local Blue Cross Blue Shield Member Services, or if you receive health insurance through your employer, reach out to your employers human resources department.

    While your Blue Cross Blue Shield plan likely covers therapy, the extent of coverage and requirements for coverage depend on your particular plan. Read on to learn more.

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    How To Verify Blue Cross Blue Shield Couples Therapy Coverage

    Athena Care is in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the easiest and quickest method to determine if BCBS couples therapy is covered.

    Find a doctor and get the help your relationship needs without all of the difficulties of contacting your insurance carrier. Let our highly experienced, expert care coordinators handle getting more information about couples therapy Blue Cross Blue Shield may cover. After completing the form, a care coordinator will review your policy and thoroughly explain your options. Rest assured, all submitted or discussed information will remain confidential.

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    Proper Speech Therapy Billing

    Current Procedural Terminology codes 92507 and 92508 are defined as speech/hearing therapy codes. Codes 92507 and 92508 are not considered time-based codes and should be reported only one time per session in other words, the codes are reported without regard to the length of time spent with the patient performing the service.

    Because the code descriptor does not indicate the time as a component for determining the use of the codes, you need not report increments of time . Only one unit should be reported for code 92507 and 92508 per date of service. Blue Cross and Blue Shield of Texas adheres to CPT guidelines for the proper usage of these CPT codes.

    Note: Unless there are extenuating circumstances documented in your office notes for example, multiple visits on the same day we will only allow one unit per date of service for these codes. Because of system limitations, our claims system previously could not identify multiple units on same day for these codes however, these limitations have now been corrected and, as of October 1, 2009, the claims system is able to adjudicate these codes to allow for only one unit per day.

    Current Procedural Terminology , copyright 2021 by the American Medical Association . CPT is a registered trademark of the AMA.

    How Does Couples Therapy Work

    A therapist observes a couples relationship and gives them feedback on their collective and individual strengths and weaknesses. They may also serve as an impartial mediator, advising both parties. As a result, couples counseling can help a couple learn more effective methods to engage, communicate, and explore ways to express their love and support for each other even when in dispute.

    When couples disagree, it is beneficial to focus on better communication instead of focusing on fighting less. Listen actively and attentively to what your partner has to say. It might be difficult to remain impartial in the heat of the moment, but learning to discuss thoughts and feelings is a vital foundation for a stronger relationship. Counseling can assist in the establishment of this foundation using the following steps:3

    • Know your issues: Identify reoccurring patterns in your disputes.
    • Concentrate on the emotional issues: Consider the current circumstance and its underlying reason when a disagreement emerges without bringing in any irrelevant material that could escalate the conflict.
    • Look for areas where you can reach a healthy agreement:Identifying a point of understanding in the middle of an argument can be beneficial and constructive.
    • Step into your partners shoes: Examine your values, opinions, beliefs, and other essential aspects of your personality. Where do they overlap, and where do they diverge from your partners? Different values may be the root of your disagreement.

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