Speech Therapy Coverage with Blue Cross Blue Shield in Illinois

BCBS provides coverage for speech therapy when it is considered medically necessary. This typically means:

• A doctor has determined that speech therapy can help you make meaningful progress.
• Therapy is expected to bring noticeable improvement within a reasonable time.
• Services are provided by a licensed speech-language pathologist.
• Treatment follows a written plan of care approved by your physician.

Common Conditions Covered

BCBS covers speech therapy for a variety of conditions, including:

• Developmental speech or language delays and articulation issues for children
• Stuttering, aphasia, and swallowing disorders (dysphagia)
• Voice disorders and vocal cord paralysis
• Speech and language difficulties due to stroke, brain injury, or neurological diseases

Important Coverage Limitations

• Some plans may limit therapy to a certain number of visits per year.
• Some plans may require a physician’s referral or prior authorization to cover care.
• Therapy focused on maintaining current skills (rather than improving them) may not be covered.
• Therapy for speech patterns that typically resolve on their own, such as natural speech dysfluency in young children, may not be covered.

Getting started with speech therapy can feel overwhelming, but you don’t have to navigate it alone. At Verse Therapy, we’re here to help you through each step and make the process as seamless as possible.

How We Support You:

1. We Verify Your Benefits – We’ll check your Blue-cross-blue-shield coverage for speech therapy services and explain what’s included in your plan.
2. We Handle Referrals & Authorizations – If your plan requires a physician’s referral or prior authorization, we’ll help coordinate with your doctor and Blue-cross-blue-shield to get the approvals needed.
3. We Match You with the Right Provider – Our team will connect you with a licensed speech therapist who fits your needs and is in-network with Blue-cross-blue-shield.
4. We Schedule Your First Appointment – Once everything is in place, we’ll help you book your initial evaluation and get started on your therapy journey with ease.

Navigating insurance can be confusing, so here’s a quick breakdown of key terms to help you understand how they may impact your care at Verse.

• In-Network vs. Out-of-Network: When a provider is in-network with Blue-cross-blue-shield, they are under contract with Blue-cross-blue-shield to provide discounted services to its members. If a provider is out-of-network with Blue-cross-blue-shield, Blue-cross-blue-shield may still cover some costs for services, but you may be responsible for more.
• Copay: This is the fixed amount you pay for each visit. If your copay for speech therapy is $30, for example, you pay that amount for each session, and Blue-cross-blue-shield covers the rest.
• Deductible: This is the amount you must pay out of pocket before Blue-cross-blue-shield starts covering costs. If your deductible is $500, for example, you’ll need to pay that amount for medical services (including those outside of Verse!) before your insurance starts contributing.
• Coinsurance: After meeting your deductible, you may still be responsible for a percentage of the cost. For example, if your coinsurance is 20%, Blue-cross-blue-shield will cover 80% of the cost of therapy, and you will owe the remaining 20%.
• Out-of-Pocket Maximum: This is the most you’ll have to pay for covered medical services in a plan year. Once you reach this limit, Blue-cross-blue-shield will cover 100% of approved services.