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
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
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.
http://www.asha.org/uploadedFiles/practice/reimbursement/coding/AuralRehabforAudandSLP.pdfhttp://www.asha.org/uploadedFiles/practice/reimbursement/coding/AuralRehabforAudandSLP.pdf
