Is Speech Therapy Covered by My Insurance?

It’s a common question to ask, especially when you want to balance finances with health. In the case of a child’s speech therapy, it’s all the more important to meet those needs.

Speech therapy works best when you give your child the time to grow and improve. Addressing speech and language difficulties early will reduce the risk of your child falling behind when they reach the classroom, and will help them be more social with their peers.

So it’s best to explore your options early for speech therapy and how your coverage may be able to handle it. Let’s discuss insurance and other funding programs in Canada available for your family’s speech therapy.

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Does My Health Insurance Cover Speech Therapy?

The usual answer is: it depends on your provider. Speech therapy may be included in employee insurance benefits and extended health insurance plans. If your insurance plan includes services from speech-language pathologists, you’re all set.

How The Process Works

Every insurance company (and policy) processes their benefits differently. They may vary depending on the severity or intensity of treatment. More severe cases and bigger treatment plans often need to be pre-approved.

Some disorders may even need a doctor’s or pediatrician’s referral that proves the need for speech therapy. Often this referral is also submitted to the insurance company before the sessions begin.

Billing methods may also vary between your insurance provider and your speech therapist. Some may have direct billing which means that the service provider will reimburse the service directly with the insurance company. In cases where they don’t, they often provide documents needed for you to file your reimbursement claim yourself.

If you received a denial of your coverage even though you have a clear speech-pathology benefit, you can also do the following:

  • Contact your insurance company to learn more about why you were denied. It may be the case that they just needed more information about the treatment. It’s best to get the details of this in writing.
  • Ask if there are any ways to make an appeal, how to do it and how long it usually takes.
  • If your employer provides insurance benefits (including your family’s benefits), contact the person coordinating the insurance at your office and provide the documentation for the denials. They may be able to reach the insurance company better on your behalf.
  • You may also contact your child’s pediatrician or speech-language pathologist and request for a letter to your insurance company that supports your child’s therapy.
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Ways Your Insurance May Still Cover Speech Therapy

There are also other means or mediums you can use in place of insurance benefits. Here are some alternatives that may be a part of your insurance’s benefits plan:

Flexible Spending Account (FSA)/Health Savings Account (HSA)

Some families have access to an FSA (Flexible Spending Account) or an HSA (Health Savings Account) as part of their health plans. They can be used to offset speech therapy costs.

An HSA is a cumulative fund that increases as you pay your coverage during the year. You’ll only be able to spend what you have accumulated, but you have an assurance that the fund is there when you need it, year after year.

An FSA account is something that’s more flexible, as per its name. It allows you to spend a total equal to the amount you’re supposed to have for the entire year. It gives you more flexibility with how much you spend, but often the coverage is gone if you don’t use it within the year.

Either one can help with your speech therapy and may even offer more flexible ways of paying.

Parent Coaching Arrangements

Some insurance plans cover parent coaching services. This may be a way to cover speech therapy for your child.

A key factor in your child’s progress through speech therapy is your support. Your child’s therapy plan may include a parent coaching component to help you understand how to support your child’s speech and language goals at home.

This can be very helpful if both parents are involved in their child’s speech therapy program and both have coverage for this, as it maximizes your family’s coverage to support your child’s speech and language needs.

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Other Funding Sources

If your insurance doesn’t cover your child’s therapy, there are a few other ways you can get assistance:

Non-Government Funding for Speech Therapy

You can apply for grants or funding help via the following private country-wide organizations. Keep in mind that you still need to apply to be considered:

  • Labatt – Better Together provides basic essentials and other support services to Canadian families and communities. Aside from helping with poverty situations, they also promote health by supporting medical provisions, including therapies.
  • Ceridian Cares also provides grants for basic and medical necessities that sustain physical and emotional well-being.
  • Jennifer Ashleigh Children’s Charity helps kids with special treatment needs and medical expenses as well.

Government Funding for Speech Therapy

Programs such as the Preschool Speech and Language Program are available in several provinces in Canada which help children from birth to before they start school.

Some programs are targeted for specific disorders. For example, the Ontario Autism Program, or OAP helps children with Autism. FSCD (Family Support for Children with Disabilities) in Alberta promotes healthy family living for disabled kids.
You can always check your provincial website to determine what programs are available in your area.

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Insurance policies may vary depending on your provider, and a key tip is to read and determine your coverage before your first visit. It’s better to know this earlier than your first session, so you can also explore and learn about the alternatives and be prepared if needed.

There are also many alternatives in case insurance doesn’t cover your speech therapy bills. Aside from helpful public provincial programs, There are many organizations that are open to helping your child’s recovery or treatment. Check your provincial website and local non-government organizations for options in supporting your family’s situation.

You can always discuss your options with your speech pathologist and which insurance providers they partner with and how they can help with reimbursement claims.

Book a consultation with Apheleia today to learn more about the financing possibilities for our speech therapy services.

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Lauren Templeton - Apheleia Speech Therapy
Lauren Templeton

Owner & Speech-Language Pathologist

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