Pease review the following information about our therapy sessions and costs.
We at ClesiaSpeech offer Synchronous Services delivered over a platform called Zoom. Not every client is an appropriate candidate for therapy via Zoom. However, we will determine this through a parent interview and after the first session.
A screening will occur before therapy sessions begin. This screening will determine if your child needs further evaluation. If an assessment is warranted, we will schedule a complete Speech-Language Evaluation. If your child has had an evaluation completed within the last six months by another licensed speech-language pathologist, we will accept it in place of performing a new evaluation, if your insurance permits. After the evaluation, there will be a determination of the need for intervention and the dosage.
When sessions occur over Zoom, a capable caregiver must be available nearby. In some cases, the caregiver must be beside the client and facilitate interaction over the platform. If the child can sit and work independently, a caregiver must still be available nearby to problem solve any technical issues that may arise during the session. We will not conduct sessions over Zoom with a child who seated in a vehicle, or any other inappropriate location. Please have your child at a table or desk, and ready for the session.
Treatment sessions are 30 minutes in length. It is advisable to be on time for your sessions. If you are late, your session will be shorter. Sessions may be once or twice per week, depending on your insurance coverage and budget
We also offer In-Person sessions, where we will visit your home for treatment. You and Dr. Duncan will be able to discuss which type of therapy will be best for your child before scheduling begins.
In Person Visits
At our Stockbridge clinic, your child will be seen by one of our Speech Therapists at their scheduled appointment time. If you would like to sit in with your child during a session, you can request this. Otherwise, your child will be welcomed into one of our awesome therapy rooms.
It is also possible to schedule Home Visits if you are located in Decatur, Georgia.
These are our fees, not considering insurance coverage.
- Speech-Language Evaluation: $150.00
- In-Person Therapy Session: $75.00
- Teletherapy 30-minute session: $70.00
- Home Visit: $100.00
Clients can make payments for services through our Client Portal on SimplePractice.
Insurance and Billing FAQ
How can I find out if my insurance will actually pay for therapy?
There are many plans that say that a child has speech therapy benefits but then turn around and deny therapy as ‘not medically necessary’. Of course we will not know for sure if your plan covers until we bill it and the Explanation of Benefits (EOB) comes back a couple of weeks after we see your child. To have a better idea if it will be covered, you can call your insurance company.
At times, dealing with insurance companies can be difficult. We recommend that you always keep a record of all correspondence and telephone calls, including date, time, and name of person you speak with.
Prior to your first appointment, you must contact your insurance company to determine your child’ speech benefits. Insurance coverage DOES NOT guarantee speech therapy benefits. The benefits you have depends on your plan.
Most insurance companies will cover the initial speech and language evaluation. However, to verify regular speech therapy visits we recommend you follow these steps:
- Contact your insurance company and ask if they cover speech therapy.
While most insurance plans do cover “speech therapy”, they typically do so only in the case of “speech disorders that are due to an accident, injury, or illness”. Most plans specifically exclude anything that they consider to be “experimental or educational” and not “restorative”, or related to “developmental delays”. Speak to your child’s pediatrician to determine the most appropriate diagnosis for your child’s difficulties.
- Your insurance company may ask you what treatment/procedure codes will be billed by our therapists.
The most common procedural codes that our therapists will use to bill are: 92506 = Speech Evaluation and 92507 = Speech Therapy.
- If they do cover it, is there a limitation on visits per calendar or contract year? When you have a limitation on visits it is your responsibility to keep track of how many you have had for the year.
- Do you need a referral from your primary care (PCP) or pediatrician?
Do you need a pre-authorization or pre-certification? If so make sure that your physician calls it in (tel. 470-491-7707), or fax it to us (404-738-2128) before your first appointment. You MUST get a prescription from the referring physician for the evaluation and treatment of speech for your child. The physician can fax it to us at the fax number listed above, or you can bring it with you on the first visit. We cannot treat anyone without a prescription. This is required to document medical necessity in case your insurance company requests treatment records. The referral prescription is unrelated to any referrals or pre-authorizations that may be required by your plan.
- Do not hesitate to contact us if you need our assistance to determine if your particular plan includes speech benefits for your child.
Our financial contract is with you.
Our financial contract is with you, not your insurance company.
We bill your insurance our current fees and accept their allowable amounts as payment only if we are their in-network provider (see the list above). We do require payment for services rendered at the time of service. This means that any copays or co-insurance that you are responsible for will be collected at the time of your visit. * If you have an annual deductible that has not been met yet, this too will be collected at the time of service.
*Note on Deductibles: In some cases, you must pay out-of-pocket up to this amount before your Insurance company starts covering services and you start paying a Co-Pay. Our Evaluation Fee is $150, and our Session Fee is $75. If you have Insurance coverage and an unmet deductible, please understand you may have to pay the full price of the evaluation and possibly one session until your deductible is met. Ask your insurance company what your deductible is to have an idea of when you can start your Co-Pays.
Our office will work with you and your family in every way possible to locate funding sources for therapy.
However, you need to be aware that we CANNOT TAKE ANY RESPONSIBILITY for the DECISIONS made by YOUR INSURANCE COMPANY.
You are ultimately responsible for payment of therapy services rendered should all other sources default.
Should you have any further insurance-related questions, please email our billing department at [email protected].