Frequently Asked Questions….

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General Questions

A screening is a very brief, overall glimpse at an individual’s communication skills. It skims over all areas of speech and language, including articulation, fluency, voice, grammar, vocabulary, conversational skills, and language memory. Screenings usually take only 15-20 minutes to conduct, and are relatively inexpensive procedures. Screenings only indicate whether further, in-depth testing is warranted in any specific communication area(s). A comprehensive evaluation is a lengthy, in-depth and detailed look at an individuals communication skills. Evaluations typically take an hour or more to administer, and are more costly. Upon completion of a comprehensive evaluation the parent or client receives a written report with specific, detailed results of all areas tested, including professional recommendations.

Yes, we accept select insurance programs and/or plans. We currently accept UHC, Aetna, BCBS (out of network), Tricare (Standard and Prime), Avmed, Onecare call, and Medicare. Please contact us to discuss any specific questions or to find out if your insurance program or plan is able to be accepted.

Yes, we accept select plans, inclusive of Sunshine Health, Amerigroup, CMS, Coventry, Medicaid, and Prestige.
Insurance clients will need a referral/prescription to receive an evaluation and therapy. Private pay clients are not required to have a referral/prescription, however if you plan to take an IRS deduction of the monies paid you may want to get a doctor’s written recommendation
Our office hours are from 8:30 AM-5PM on Mondays, 8:30 AM-7 PM on Tuesdays and Thursdays, 8:30 AM-6 PM on Wednesdays and 8:30-3 on Fridays. Please contact us to discuss a therapy schedule or if you must request a special time, such as a later evening or weekend.
We typically require payment for services when the service is provided. However, please contact us if you require a different payment schedule due to financial restrictions. We will do our best to accommodate your request.
Yes! We are able to co-treat with therapists of any other disciplines, including but not limited to: Occupational Therapists, Physical Therapists, Massage Therapists, Behavior Analysts/Therapists, Audiologists, Psychologists, Neuro-Psychologists, Ear-Nose-and-Throat physicians, and many more. Also, if you feel that your child requires additional therapy services, such as physical therapy, we would be happy to refer you to several excellent professionals of the above mentioned disciplines.
Yes, we accept credit cards for payment of services. We also accept Health Saving Accounts (HSA).
Here at Therapy Essentials we do ask that you complete our intake packet and return it to our office prior to your appointment date.

Speech and Language Questions

Some insurance companies do cover or reimburse payment for speech and language therapy services. Each client should check with his or her own company and review their policy coverage and restrictions to confirm. Please refer to the questions to ask your insurance company link.
Each speech and language disorder or delay is unique and can be caused by a variety of factors. It is important to have suspected speech and language problems evaluated by a licensed speech-language pathologist. After a full evaluation, a reason or possible cause, for the disorder or delay can be discussed.
Each case is different, but for the most part, clients are seen twice a week for 30-45 minute sessions. More involved children, like children may require more sessions per week, or 60 minute sessions.
Typically physicians or teachers will notice a delay or disorder in a child’s communication skills. They may recommend that your child be evaluated. Parents may also notice a delay in communication skills, and should discuss their concerns with their child’s doctor and teacher, or contact a speech-language pathologist for an evaluation. Parents may also notice behavior problems arising from school-aged children due to increased frustrated with their communication problems. Thees children aren’t sure of how to express their problems to adults. In any case, if you are concerned about your child’s speech and language development and/or use, please contact us to schedule an appointment.
No, please contact us for an appointment to evaluate your child’s communication skills immediately. Typically, if children are showing a delay in communication skills at this young of an age, treatment is quick, as early intervention works very fast and effectively. It is always better to be safe than sorry! Your child now could be lacking only some comprehension of basic language concepts, but if not treated now, could develop into academic, social, communication, and behavioral difficulties down the road.
School districts operate under separate guidelines than private practitioners. For a child to receive speech and language therapy in the schools it must prove to be “educationally relevant” and must focus on educational goals and objectives. Your child may have been dismissed because they had reached a higher functioning communication level, and it was no longer “educationally relevant” for them to be seen at school. If you feel that your child still needs speech and language services, you have the right to pursue private treatment from a speech-language pathologist in a private practice setting.
Early Steps is a federally funded program that has specific criteria for children to qualify for services. Just because your child did not qualify for services from Early Steps does not mean they do not need skilled services. They just do not qualify for Early Steps to pay for your child to receive therapy. If your child is receiving services from Early Steps (i.e. an ITDS provider is coming to your home) you still have the ability to receive private services on your own via your insurance or private pay.

Questions to Ask your Insurance Carrier

Call your insurance company and ask what documentation is required to get assessment coverage. Some insurance companies will require a written prescription (referral) from the doctor. Typically the utilization management department (authorizations) of the insurance company handles these matters.
Parents are encouraged to be proactive in this process. Just asking if you are covered for “speech” therapy is not enough to determine if you are covered for the specific treatment you need. When asking about coverage, ask specific questions, such as which diagnostic (ICD-10) and procedure codes (CPT) are covered by the plan.
You will often find insurance companies will cover the assessment but not the therapy sessions.
Most speech therapy coverage is very limited for pediatric speech-language pathology services unless need for therapy is as a result of accident, injury, or other illness. Some policies exclude children by age and/or others refuse to cover school age children because they are expected to receive speech language services in school settings. Other policies may state that they will pay for treatment of problems related to medical conditions, but will not pay for autism or developmental delays (e.g. late talkers, articulation deficits).

Speech & Language Services and Autism Spectrum Disorder
When seeking speech language services for children diagnosed with Autism Spectrum Disorders, over 35  states provide insurance coverage. In Florida the coverage is as follows Fla. Stat. Ann. §627.6686

  1. Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder.
  2. Treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy, and applied behavior analysis.
    Coverage for the services shall be limited to $36,000 annually and may not exceed $200,000 in total lifetime benefits for an individual under 18 years of age or an individual 18 years of age or older who is in high school who has been diagnosed as having a developmental disability at 8 years of age or younger.

*Despite this State mandate, many large employers have found a way to circumvent this statue by making their plan “Self-funded.”

If you are denied coverage, always ask for the denial in writing. This document will state the denial reason and you will use that to follow your insurance’s appeal procedures. Insurance companies count on consumers not appealing decisions; and the fact is that most people don’t do it because it is time consuming.
Along the way, document all conversations with insurance representatives. Documentation can be very helpful for an appeal. In some states, even if you have exhausted appeal procedures within your insurance company, you can appeal to your state’s insurance commission, some of which allow for the filing of complaints online.

Therapy Essentials Inc., is a Premier Provider of Speech and Language Services in the Central Florida Area

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