Fees, Insurance, and Medicaid

Insurance and Medicaid

 

Marci Adilman Speech Therapy is an out of network provider. I have chosen to build a patient-centered model for the practice that does not allow insurance companies to dictate the care that I provide. As a specialist in speech, language, feeding, and myofunctional therapy, I want to determine with the client, and the client's family, what your goals are and the length and timing of therapy. I do this based on best practices and not cost effectiveness, which is what insurance pushes many therapists to do. This means that I do not contract with insurance carriers, and I do no insurance billing directly with private insurance companies. However, I am happy to provide you with the appropriate super bills, which are receipts for speech therapy services containing the relevant diagnosis and treatment codes. 


Periodically insurance companies may request documentation regarding speech therapy services, and I routinely provide evaluation and updates progress reports as requested. I am also happy to contact your physician with your written permission to obtain a prescription for speech therapy services. I have seen clients receive anywhere between 50-80% of the cost of therapy reimbursed; however, it is important to remember Marci Adilman Speech Therapy, LLC is defined as the service provider, and I never imply nor suggest any specific benefits your insurance company may or may not provide.

Many insurance companies provide coverage benefits and reimbursement to you for speech therapy services. However, many carriers are not recognizing speech therapy as a covered benefit. I advise direct contact with your insurance carrier directly to verify the specifics of any benefits you may have.


I suggest the following questions:

1. Does my policy provide for speech therapy services?

2. What diagnosis codes are acceptable for speech therapy reimbursement?

3. What is the reimbursement rate?

4. Do my benefits cover the speech therapy as well as the speech evaluation?

Marci Adilman Speech Therapy is currently a Medicaid provider and is currently accepting new Medicaid clients, including Katie Beckett Deeming Waivers. We are in network with straight Medicaid only and are unable to file with CMOs at this time (Peachcare, Amerigroup, Caresource, WellCare). Medicaid treatment sessions are typically 30-40 minute sessions.

Private Pay Fees and Schedules

 

All fees for speech therapy sessions and evaluations are due at the time of service by cash or check, or if paying by credit card, HSA, or FSA, cards are kept on file and will be billed by the close of the business day that the session and/or evaluation took place. All clients are required to keep an updated, active credit card on file.

 

Individual Speech & Language Therapy Session Fees

 

Speech & Language Therapy (sessions are 55 minutes plus 5 minutes for parent/teacher communication and note writing): $130 (60 minute session)

Speech & Language Therapy (sessions are 40 minutes plus 5 minutes for parent/teacher communication and note writing): $110 (45 minute session)

Speech & Language Therapy (sessions are 25 minutes plus 5 minutes for parent/teacher communication and note writing): $75 (30 minute session)

Please inquire about our pre-pay discounts for monthly, up-front payments.

Individual Speech, Language, Feeding, and Oral-Motor Evaluation Fees

 

Please note, all evaluations include parent interviews, standardized and non-standardized testing, speech and language sampling, oral mechanism exam, and a full and comprehensive written report released to the family within 2 weeks of the initial evaluation session. When necessary, they may also include school/daycare/home observations, record reviews, and teacher interviews.

 

  • Oral Motor/Articulation Evaluation (including tongue thrust and reverse swallow) with Evaluation of Feeding Skills (feeding skills are always included when articulation deficits are present to see how the oral motor structures coordinate for non-speech tasks like chewing, swallowing, etc.): $350

 

  • Comprehensive Language Evaluation (Receptive and Expressive Language, and skills in the area of Pragmatics) : $350

  • Combined Comprehensive Oral Motor/Articulation with Evaluation of Feeding & Comprehensive Language Evaluation: $450

 

  • Articulation & Language Evaluation for children under 3 years: $250

 

Other Relevant Fees

  • Professional Letter (to doctors, school, insurance companies, etc): First letter is complimentary, emailed for multiple uses on company letterhead, and will cite most recent research and evidence to assist and advocate on behalf of your child; each additional letter: $25 per letter

  • Conference with other Medical or Therapeutic service providers, or IEP meeting$130 per hour

 

  • Travel Fee/Expense for conference with providers/IEPs (effective July 11, 2019 for all clients, including those with insurance and medicaid)$10

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© 2019 by Marci Adilman Speech Therapy.