Friday, August 22, 2014

Inquire About Eligibility and Benefits for Auditory Rehabilitation

Steps to Inquire About Eligibility and Benefits

Call the member services number on the back of your insurance card 
to inquire about eligibility and benefits for auditory rehabilitation.

Below are the CPT or procedure codes.

RE: THERAPY TYPE: Auditory (re)habilitation, Auditory-Verbal Therapy
CPT CODE: 92630 auditory rehab, prelingual hearing loss
CPT CODE: 92633 auditory rehab, postlingual hearing loss

RE: THERAPY TYPE: Auditory Processing Disorder
CPT CODE:  92626 Auditory Rehabilitation, 1st hour

Each plan is different and services may be subject to a deductible, coinsurance, or copayment.  Clients with Health Maintenance Organization (HMO) plans are responsible for getting a referral from the primary care physician prior to receiving services.  Lynn A. Wood is not responsible for denials on insurance claims, and clients are responsible to pay for services rendered.

Questions to Ask When Inquiring About Eligibility

It may be helpful for you to contact your insurance company and ask the following questions so you are aware of your insurance benefits.

1.    What are my outpatient benefits for auditory rehabilitation?

2.    Do I have a deductible?

3.    What is my co-pay or co-insurance percentage?

4.    How many visits do I get per calendar year?

5.    Do I need a referral or authorization prior to my visits? How often?

6.    Is my plan’s coverage of outpatient auditory rehabilitation based upon medical necessity? If so, what diagnoses are covered under “medical necessity”?

7.    What is the effective date of my coverage?

8.    Is Lynn A. Wood, M.A. CCC/A LSLS Cert. AVT in your provider network?

            NPI #: 1295853919

            Illinois Licensed Audiologist #147-000172

            Listening and Spoken Language Specialist, Certified Auditory-Verbal
            Therapist #70712318

9.    If not, who is an in network provider that is a Certified Auditory Verbal Therapist and a Licensed Rehabilitative Audiologist within 30 miles from my home?

10. If they do not have a provider in in network, request reimbursement at the in network rate.

Some insurance plans do not cover therapy services unless they are considered to be "medically necessary." Contact your insurance company to inquire about medical necessity guidelines that may apply to your plan

If services are denied, you have a right to appeal the health insurance company for speech-therapy coverage.  The American Speech-Language-Hearing Association (ASHA) has published a document on medical review guidelines that can be used as part of the appeals process.

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