Any success getting insurance to cover dyslexia remediation?

[summerreading]

My son's insurance covers the CPT code for remediation, but only if the doctors are in network. Since the reading tutor he is going to be going to are not doctors they aren't listed. They can call the insurance and see if they would work with them, but the center already said remediation might not be covered because they are teachers not doctors.  A psychologist did his testing. Do they also do remediation?

 

Just wondering if anyone is getting remediation covered.

[OneStepAtATime]

I'm no expert but AFAIK the remediation of things like reading/spelling/writing/math is not done by a psychologist, at least not one I have ever heard of, but they may do remediation of other things and I am just not aware of it. Our insurance won't cover that type of thing even if the person has a ton of certifications because the people doung the remediation aren't in the medical field. Diagnosis is sometimes covered but remediation is much harder to get covered, especially if it isn't tied to vision/hearing or the need for occupational therapy.

[FairProspects]

Wow, no. What CPT code is that? I've never even heard of it. I don't know any remediation centers that are even credentialed to take or bill insurance. It falls under education here other than some of the evals by the psych or neuropsych.

[summerreading]

Wow, no. What CPT code is that? I've never even heard of it. I don't know any remediation centers that are even credentialed to take or bill insurance. It falls under education here other than some of the evals by the psych or neuropsych.

 

The dyslexia center gave me these codes to look up:

 

CPT, or procedure code:  90837   Treatment

ICD-9, or diagnosis code:  784.61   Alexia and Dyslexia

ICD-10, or diagnosis code:  R48.0   Dyslexia and Alexia

[laundrycrisis]

We were able to get some coverage for vision therapy for convergence insufficiency.  It was creating a visual problem that  was greatly affecting his reading, causing some of his dyslexia symptoms.  

[summerreading]

I'm no expert but AFAIK the remediation of things like reading/spelling/writing/math is not done by a psychologist, at least not one I have ever heard of, but they may do remediation of other things and I am just not aware of it. Our insurance won't cover that type of thing even if the person has a ton of certifications because the people doung the remediation aren't in the medical field. Diagnosis is sometimes covered but remediation is much harder to get covered, especially if it isn't tied to vision/hearing or the need for occupational therapy.

 

Thanks, this is what I thought. Was hoping there was something I missed.

[OneStepAtATime]

Thanks, this is what I thought. Was hoping there was something I missed.

Wish I had better news.

[MistyMountain]

A place around here uses speech therapists and they are able to get it covered under that for some people. Our insurance covered it 80 percent but speech therapists charge 3 times as much as a regular tutor so it still was costly for us. Also only 30 sessions were covered which does not go far. People who have state insurance were probably covered but we are just over that amount.

[FairProspects]

Ok, CPT code 98037 is just an office visit code for a 52-60 minute visit. I'm a billing specialist. :) It's not a specialized code for dyslexia remediation. In order to successfully use that code with your insurance, the provider would have to be in-network and credentialed. I don't know of learning specialists other than neuropsychs or psychs who are on insurance panels - at least they aren't in our state. And psychs are not usually the ones providing the remediation. When I look up those codes, the results I get are that those ICD 9/10 codes are used primarily by speech language pathologists & audiologists, rather than for any kind of specific educational remediation. But it probably depends on the insurance laws in your state and whether you have insurance coverage for neurodevelopmental issues. Our state does not require that kind of coverage so most plans don't provide it.

 

Do you have insurance coverage for dyslexia or neurodevelopmental issues under that ICD 9/10 code? Is the office and provider in-network and credentialed with your insurance company? Is the remediation provided by a speech therapist?  If the answer to all is yes, then yes, I would suspect you should be able to get insurance to cover the visits subject to your deductible and coverage terms.

[summerreading]

Ok, CPT code 98037 is just an office visit code for a 52-60 minute visit. I'm a billing specialist. :) It's not a specialized code for dyslexia remediation. In order to successfully use that code with your insurance, the provider would have to be in-network and credentialed. I don't know of learning specialists other than neuropsychs or psychs who are on insurance panels - at least they aren't in our state. And psychs are not usually the ones providing the remediation. When I look up those codes, the results I get are that those ICD 9/10 codes are used primarily by speech language pathologists & audiologists, rather than for any kind of specific educational remediation. But it probably depends on the insurance laws in your state and whether you have insurance coverage for neurodevelopmental issues. Our state does not require that kind of coverage so most plans don't provide it.

 

Do you have insurance coverage for dyslexia or neurodevelopmental issues under that ICD 9/10 code? Is the office and provider in-network and credentialed with your insurance company? Is the remediation provided by a speech therapist?  If the answer to all is yes, then yes, I would suspect you should be able to get insurance to cover the visits subject to your deductible and coverage terms.

 

Thank you for the information on the codes! I don't think it's going to happen with my insurance, so moving on to plan B now, aka Grandpa :P

[Plink]

No luck here either, but our CPA said that we could deduct DD's tutoring expenses. This only works if you have a medical diagnosis from a doctor documenting the disability.