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
- Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder.
- 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.”