Diagnosis Destinations Articulation Disorder Insurance Public Schools are Responsible for Providing Speech Therapy for School-Age Children

Reason for Denial: "Public Schools are Responsible for Providing Speech Therapy for School-Aged Children"

Public schools are responsible for insuring that the child can receive benefit from his or her education. In other words, the schools are responsible for the educational needs of the child. The medical community (of which speech-language pathologists are members) is responsible for the medical needs of the child and, if you have medical insurance, the insurance company is responsible for payment of such, per the conditions in your contract. In other words, unless your contract specifically states that speech therapy will not be covered for any school-aged child, the school's responsibility is not a concern of the insurance company or HMO. The services sometimes overlap, but the public school is not a medical provider any more than the medical provider is an educational institution. You will, however, need to check your state's insurance legislation, as the state of Washington, for example, apparently limits coverage of speech therapy services (via medical insurance) for all school-aged children. (This link will guide you to resources at your state government: http://www.makingakilling.org/appendix2.html)

We recommend that during an appeal of a denial based on the school district's responsibilities, you state the delineation of responsibilities. For example, include this phrase in your letter:

Per the Individuals with Disabilities Education Act (also referred to as IDEA, see The United States Department of Education, Office of Special Education and Rehabilitative Services, http://idea.ed.gov/, public schools are responsible for insuring that a child can receive benefit from his or her education. IDEA provides for the needs for children as they relate to education. IDEA does not provide for the medical needs of my child, which is why I have health insurance coverage for him/her.

In addition, the insurance company might ask for a copy of the paperwork such as the IEP (Individualized Education Plan) which outlines the services that the school district is providing for your child. If you are asked to provide a copy of the IEP, specify how the school district's speech therapy services differ from the private (insurance-reimbursed) speech therapy services. While the services might overlap in some ways, you obviously have a reason for having determined that there is a need for both services. Some examples of how they might differ include the number of children in the therapy sessions and whether or not oral motor skills (like feeding, swallowing, etc.) are taught.

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