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Dyslexia and insurance coverage?


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All --

 

I am wondering if anyone has had any success in getting their insurance to cover dyslexia therapy?  My dd has been diagnosed with a reading delay due to a phonological processing delay which has been, over the last several months, been successfully (tho not fully) addressed with therapy.  Her therapy is provided by certified tutor; my insurance will cover this therapy but ONLY if it's delivered by a speech pathologist.  There is no speech therapist in the area that provides the specific therapy that she was prescribed (and is doing well on), so I am gearing up for an appeals process with the insurance company.

 

I've been working with the insurance commissioner in my state and the Department of Labor, and they both agree that the first step is for me to file a claim and be rejected so that the appeals process can progress.

 

My tutor doesn't file on insurance, of course, so I've come to a dead end -- with something I think should be easy to find: the right billing code.  I can't submit the claim until I have the billing code....which means no rejection...which means no appeal....sigh.  I might lose in the end, but for what tutoring costs, it's worth the fight.

 

Has anyone had success in filing a claim for dyslexia therapy with their insurance (not assessment/diagnosis) -- and if so, do you recall what code you used?

 

Many thanks.

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No but I hope someone can provide answers.  Actually for us it wasn't therapy but reading remediation.  We used a reading/writing/spelling program designed specifically for dyslexics.  I had not considered what we were doing therapy so it never occurred to me to go that route.  What type of therapy are they doing?  

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According to the American Speech-Language-Hearing Association (professional organization for Speech & Language Pathologists) treatment of language-based learning disabilities does fall within  the Scope of Practice for SLP. One of the days of the seminar I did this week was devoted to intervention for reading comprehension and writing.

 

Now most SLP's do not get training for LBLD intervention nor do they have much experience with it. So I would be cautious about hiring a SLP to do it. Not to suggest that any particular SLP would be a bad choice, but make sure you ask questions about that individual's qualifications. I would want to see more than just a 6 hour training seminar like the one I did this week. It had some good information but it doesn't substitute for a certification like the Academic Language Therapy Association's one or the Association of Educational Therapist's one. Or a graduate certificate like the ones offered by UC Riverside, Southern NH U/Landmark School, or U of San Diego/Dyslexia Training Institute.

 

Insurance isn't likely to reimburse for LBLD intervention provided by a tutor rather than a SLP since it would be seen as educational rather than medical.

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  • 3 weeks later...

Many, many thanks for the responses.  I've been slow in responding due to some unforeseen chaos (isn't that always true?), but a couple of comments......

 

I realize I'm being imprecise with my language here.  Please forgive me -- this is all sort of new to me.  My daughter's "therapy" is probably misnamed -- it's not therapy, it's the Wired for Reading program that I think is often used with dyslexic kids.  

 

The only reason I think we have some hope here is that her reading challenges are caused by the phonological delay, which my insurance company recognizes as a developmental delay.  Interventions of all sorts to address developmental delays are covered by my insurance (which i realize is quite generous), hence my attempts to get insurance to cover it.  The company self-insures, so realistically, they can cover anything they choose to cover -- which is the only reason why i'm pushing. It will take an appeals process, but I can't get the appeals process started until I get denied -- hence my desire to find the billing code.  They won't process (and deny) the claim until I have that information.  Of course they won't give it to me.

 

I'll keep looking....if anyone knows, much appreciate the help.  And many thanks for the comments/guidance above -- it's helpful to hear others' experiences.

 

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One local place that does Barton tutoring trains speech therapists in the Barton method to handle the kids with state insurance or private insurance that covers tutoring done by a speech therapist. So it can be covered but a lot of people with private insurance do not have coverage for it.

Edited by MistyMountain
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