Many health insurance plans offer some coverage for speech therapy services, however there are often restrictions or limitations to this coverage. Coverage varies between different insurance carriers, and between different plans within a company.  In short, every insurance and every plan is unique.


Morgan Hill Speech is an ‘Out of Network’ Provider for the majority of health plans. ‘Out of network’ means we do not have a contract with the insurance company and therefore have no guarantee that they will reimburse us for our services.  We ensure that clients fully understand their financial obligations before beginning services and present all possible scenarios to our clients. 

At Morgan Hill Speech we provide a claims submission service as a courtesy to our clients.  We are submitting claims to your insurance as an ‘Out of Network’ Provider.  This is not a guarantee of payment.   This means that Morgan Hill Speech will collect payment for our services within the week of service; submit claims to your insurance on your behalf within 48-72 hours; and then assign payments to be sent directly to you. 

Morgan Hill Speech will not appeal claims that insurance chooses to deny or underpay.  Morgan Hill Speech does not have access to the specifics of your insurance plan, nor do we have control over their decision making process.  Your relationship with your insurance company is private.  Typically, the insurance company will provide you with an Explanation of Benefits (EOB) within 30-45 days after a claim has been submitted.  You are responsible for reading each Explanation of Benefits (EOB) and maintaining communication with the insurance company.


If you are planning to use our claims submission service, we highly recommend that you contact your insurance to ask about your benefits for speech and language services.  We recommend you do this before we schedule an assessment; this way you will have a better understanding of your insurance coverage.  We have gathered a list of suggested questions to guide your conversation with your insurance company. 


Copay: A predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician.  Your out of network copay may be different to your in-network copay.

Deductible: The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your own care out-of-pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.  Your out of network deductible may be higher than your in network deductible.

Coinsurance: Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, that typically applies after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.

Out-of-pocket maximum: The most you could have to pay in one year, out of pocket, for your health care before your insurance covers 100% of the bill.  Your out of pocket maximum may be higher for your out of network plan.


  • Do you have in network speech and language therapy services where I live?
  • Does my policy cover speech and language therapy services at the out of network level?
  • Are there any conditions that are specifically covered or excluded? There may be a list  of diagnosis codes, also known as ICD-10 codes. 
  • What Treatment Codes are covered? A treatment code is also known as a CPT code and may determine whether an evaluation or treatment is covered.  Our CPT codes are 92523 for an assessment and 92507 for our treatment sessions.
  • Do I Need a prescription or referral from a pediatrician before beginning services? 
  • Do I need prior authorization or precertification?  You may need to work with your pediatrician on this.  
  • How Many Sessions will be covered? Is there a specific time frame during which they need to be completed?(e.g. 60 consecutive days, within 6 months, calendar year etc.) 
  • Do I Have a deductible or co-pay?  If so, how much is it? 
  • What Type of documentation will you need (e.g. reports, progress notes)?  How Often will you need these?  Insurance companies typically require a written initial assessment and treatment plan.  They also generally require that your child has a formal assessment and updated treatment plan every year.