Cigna speech therapy exclusions

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Treatment for a related condition resulting from any kind of substance or alcohol use or misuse. Treatment needed because of, or relating to, male or female birth control, including but not limited to: surgical contraception, namely: vasectomy, sterilisation or implants; non surgical contraception, namely: pills or condoms; family planning, namely: meeting a doctor to discuss becoming pregnant or contraception.

Treatment relating to infertility other than investigation to the point of diagnosis , fertility treatment of any sort, or treatment of complications arising as a result of such treatment. We will pay for investigations into the cause of infertility if: the specialist wishes to rule out any medical cause; the beneficiary has been covered under this policy for two 2 consecutive years before the investigations have commenced; and the beneficiary was unaware of the existence of any infertility problem, and had not suffered any symptoms, when their cover under this policy commenced.

We will not pay maternity benefits: to a beneficiary who acts as a surrogate; or to anyone else acting as a surrogate for a beneficiary. These children can only join once they are ninety 90 days old, and will be subject to medical underwriting. Nursery care for a newborn in hospital, unless the mother is required to remain in hospital due to medical necessity for treatment that is covered by this policy. Preventative treatment, including but not limited to health screening, routine health checks and vaccinations unless that treatment is available under one of the options for which a beneficiary has cover.

We will pay for preventative surgery when a beneficiary: has a significant family history of a disease which is part of a hereditary cancer syndrome such as ovarian cancer ; and has undergone genetic testing which has established the presence of a hereditary cancer syndrome.

Please note that we will not pay for the genetic testing. Under the International Medical Insurance plan, the limits of cover for preventative surgery in respect of congenital conditions will apply, other than for cancer. Treatment for sexual dysfunction disorders such as impotence or other sexual problems regardless of the underlying cause. Treatment in the USA, unless the beneficiary has purchased Worldwide including USA cover under this policy, or the treatment can be covered under the Out of Area Emergency cover conditions.

Treatment in the USA where the Worldwide including USA cover was purchased if we know or reasonably suspect that the cover was purchased and the beneficiary travelled to the USA for the purpose of receiving treatment. Treatment which is intended to change the refraction of one or both eyes, including but not limited to laser treatment, refractive keratotomy and photorefractive keratectomy. We will pay for treatment to correct or restore eyesight if it is needed as a result of a disease, illness or injury such as cataracts or a detached retina.

Any treatment outside your selected area of coverage, unless the treatment can be covered under the Out of Area Emergency cover conditions. Travel costs for treatment including any fares such as taxis or buses, unless otherwise specified, and expenses such as petrol or parking fees. Any expenses for international emergency services which were not approved in advance by the medical assistance service, where applicable.

International services expenses for emergency evacuation, medical repatriation and transportation costs for third parties where the treatment needed is not covered under this policy. Any expenses for ship-to-shore evacuations. Gender reassignment surgery, including elective procedures and any medical or psychological counselling in preparation for, or subsequent to, any such surgery.

Treatment which is necessary because of, or is any way connected with, any injury or sickness suffered by a beneficiary as a result of: taking part in a sporting activity on a professional basis; solo scuba-diving; or scuba-diving at a depth of more than thirty 30 metres unless the beneficiary is appropriately qualified namely PADI or equivalent to scuba-dive at that depth. Treatment which in our reasonable opinion is experimental, is not orthodox, or has not been proven to be effective.

Any form of plastic, cosmetic or reconstructive treatment, the purpose of which is to alter or improve appearance even for psychological reasons, unless that treatment is medically necessary and is a direct result of an illness or an injury suffered by the beneficiary, or as a result of surgery. Costs or fees for filling in a claim form or other administration charges. Costs that have been or can be paid by another insurance company, person, organisation or public programme.

If a beneficiary is covered by other insurance, we may only pay part of the cost of treatment. If another person, organisation or public programme is responsible for paying the costs of treatment, we may claim back any of the costs we have paid. Treatment that is in any way caused by, or necessary because of, a beneficiary carrying out an illegal act.

That is because unlike other therapies e. Consequently, below are some explanations of what speech therapy services your insurance may actually cover. In the majority of cases it is usually the pediatrician who gives a referral for speech therapy services or at least for a speech language assessment. It is important to note that most insurance policies will cover partially or completely initial speech and language evaluations even if the speech therapist is out of network.

The first step is to call your insurance company and ask them what documentation is required to get assessment coverage. Here, depending on your insurance company, responses might vary.

Some insurance companies require a written prescription from the doctor coupled with the precertification interview with the treating speech therapist. Typically the utilization management section of the insurance company deals with the precertification interview. After precertification takes place, make sure to ask your insurance representative regarding the coverage for the out of network therapists. They will instead provide you with a letter for your insurance company, containing the necessary diagnosis and treatment codes, incurred fees as well as a brief description of services provided, and will expect you to apply for reimbursement on your own.

Note: Parents should not assume that if assessment is provided in an outpatient hospital setting their health insurance will pay the bill. In many cases insurance denials result in the parents having to pay the full cost of the services provided.

Hospital services can be very expensive. Consequently, even if you do decide to seek assessment services from an outpatient hospital setting, you still need to check with your insurance company to make sure that this service will be covered. The first step to insurance coverage for assessment is to speak to the insurance representative directly, even if your service provider had already done so for you.

Parents are encouraged to do the above in order to avoid any misunderstanding and confusion, which may lead to costly errors. Therefore, when asking about coverage, you want to ask which diagnostic and procedure codes your speech therapist should use to help assure the codes used accurately reflect the coverage you have.

It is always better to learn and clearly understand information firsthand rather than from a third party, especially because the same coverage that pays for assessment may not cover therapy services: a fact that baffles and outrages many of the parents. To reduce confusion, take detailed notes during all conversations with the insurance company.

You may get conflicting information from different people at the insurance company and it will be important for you to write everything down as you move through this process. Therapy coverage The truth is that most commercial health insurance speech therapy coverage is very limited for pediatric speech-language pathology services. Many policies exclude children by age e.

Others refuse to cover school age children because they specify that the child is expected to receive speech language services in school settings. Some policies exclude children with congenital conditions, regardless of the nature or severity. Other policies state that they will pay for treatment of problems related to medical conditions, but will not pay for autism or developmental delays e.

A research of a few selected major insurance companies e. Limits: treatment for a day period per incident of illness or injury. Requires referral of PCP and prior approval by Aetna. Blue Cross Blue Shield Covers: Outpatient short-term rehabilitation services for conditions which are expected to show significant improvement through short-term therapy, as determined by the PCP.

Limits: Limited to a maximum of 30 visits per calendar year. Covered for correcting speech disorders that are the result of diagnosed medical illness, surgery, or accidents only. United HealthCare Covers: Short-term speech therapy provided under the direction of a participating provider. Limits: Limited to 20 visits per member per calendar year.

Requires prior approval. Inpatient services are covered under the medical inpatient benefits. Excludes: Speech therapy for children of school age as these services must be provided through the school system. Some insurance companies tend to explicitly specify exclusions to services. However others do not explicitly state what kind of conditions will be excluded from coverage. Diagnoses that may be excluded from coverage include:.

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Treatment for obesity, or which is necessary because of obesity. This includes, but is not limited to, slimming classes, aids and drugs.

We will only pay for gastric banding or gastric bypass surgery if a beneficiary: has a body mass index BMI of forty 40 or over and has been diagnosed as being morbidly obese; can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four 24 months; and has been through a psychological assessment which has confirmed that it is appropriate for them to undergo the procedure.

Treatment in nature cure clinics, health spas, nursing homes, or other facilities which are not hospitals or recognised medical treatment providers. Charges for residential stays in hospitals which are arranged wholly or partly for domestic reasons or where treatment is not required or where the hospital has effectively become the place of domicile or permanent abode.

Treatment for a related condition resulting from addictive conditions and disorders. Treatment for a related condition resulting from any kind of substance or alcohol use or misuse.

Treatment needed because of, or relating to, male or female birth control, including but not limited to: surgical contraception, namely: vasectomy, sterilisation or implants; non surgical contraception, namely: pills or condoms; family planning, namely: meeting a doctor to discuss becoming pregnant or contraception.

Treatment relating to infertility other than investigation to the point of diagnosis , fertility treatment of any sort, or treatment of complications arising as a result of such treatment.

We will pay for investigations into the cause of infertility if: the specialist wishes to rule out any medical cause; the beneficiary has been covered under this policy for two 2 consecutive years before the investigations have commenced; and the beneficiary was unaware of the existence of any infertility problem, and had not suffered any symptoms, when their cover under this policy commenced.

We will not pay maternity benefits: to a beneficiary who acts as a surrogate; or to anyone else acting as a surrogate for a beneficiary. These children can only join once they are ninety 90 days old, and will be subject to medical underwriting.

Nursery care for a newborn in hospital, unless the mother is required to remain in hospital due to medical necessity for treatment that is covered by this policy.

Preventative treatment, including but not limited to health screening, routine health checks and vaccinations unless that treatment is available under one of the options for which a beneficiary has cover. We will pay for preventative surgery when a beneficiary: has a significant family history of a disease which is part of a hereditary cancer syndrome such as ovarian cancer ; and has undergone genetic testing which has established the presence of a hereditary cancer syndrome.

Please note that we will not pay for the genetic testing. Under the International Medical Insurance plan, the limits of cover for preventative surgery in respect of congenital conditions will apply, other than for cancer. Treatment for sexual dysfunction disorders such as impotence or other sexual problems regardless of the underlying cause.

Treatment in the USA, unless the beneficiary has purchased Worldwide including USA cover under this policy, or the treatment can be covered under the Out of Area Emergency cover conditions.

Treatment in the USA where the Worldwide including USA cover was purchased if we know or reasonably suspect that the cover was purchased and the beneficiary travelled to the USA for the purpose of receiving treatment.

Treatment which is intended to change the refraction of one or both eyes, including but not limited to laser treatment, refractive keratotomy and photorefractive keratectomy. We will pay for treatment to correct or restore eyesight if it is needed as a result of a disease, illness or injury such as cataracts or a detached retina.

Any treatment outside your selected area of coverage, unless the treatment can be covered under the Out of Area Emergency cover conditions. Travel costs for treatment including any fares such as taxis or buses, unless otherwise specified, and expenses such as petrol or parking fees. Any expenses for international emergency services which were not approved in advance by the medical assistance service, where applicable.

International services expenses for emergency evacuation, medical repatriation and transportation costs for third parties where the treatment needed is not covered under this policy.

Any expenses for ship-to-shore evacuations. Gender reassignment surgery, including elective procedures and any medical or psychological counselling in preparation for, or subsequent to, any such surgery. Treatment which is necessary because of, or is any way connected with, any injury or sickness suffered by a beneficiary as a result of: taking part in a sporting activity on a professional basis; solo scuba-diving; or scuba-diving at a depth of more than thirty 30 metres unless the beneficiary is appropriately qualified namely PADI or equivalent to scuba-dive at that depth.

Treatment which in our reasonable opinion is experimental, is not orthodox, or has not been proven to be effective. Cigna plans cover speech therapy for autism as long as the services are medically necessary, are not specifically excluded by the plan, and are provided by a licensed practitioner.

Autism is a disorder that requires medical intervention to be managed. A diagnosis of autism spectrum disorder ASD usually includes a recommendation for speech therapy, which will help improve speech and communication skills. Cigna is an insurance company that provides coverage for a range of mental health services, including speech therapy. Cigna offers its members access to a list of providers in its network who are trained as speech therapists and can help people with autism develop effective communication skills.

Speech therapy is a type of treatment that can be used to help individuals with autism communicate more effectively with others. This is often done through the use of specialized speech-language pathologists SLPs who work with patients on developing strategies for communicating with their peers and family members.

Speech therapy is one way to help people who have autism build better relationships with others and be able to communicate their needs more easily.

Speech therapy is a service that is covered by Cigna, provided that you have a policy that includes coverage for speech therapy and the other conditions speech therapy addresses. Each policy is different, and the specific conditions it covers vary according to the provider. Speech therapy is a service provided by a professional, such as a licensed speech-language pathologist SLP , to help people with communication disorders.

Speech therapists often work with people who have problems expressing themselves through speech or understanding language.

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Treatment which is necessary as a result of conflict or disaster including but not limited to: nuclear or chemical contamination; war, invasion, acts of terrorism, rebellion whether or not war is declared , civil war, commotion, military coup or other usurpation of power, martial law, riot, or the act of any unlawfully constituted authority; any other conflict or disaster events; where the beneficiary has: put him or herself in danger by entering a known area of conflict as identified by a Government in your Country of nationality, for example the British Foreign and Commonwealth Office ; actively participated in the conflict; or displayed a blatant disregard for their own safety.

Treatment that arises from, or is in any way connected with attempted suicide, or any injury or illness that the beneficiary inflicts upon him or herself.

Treatment for or in connection with speech therapy that is not restorative in nature, or if such therapy is: used to improve speech skills that have not fully developed; can be considered educational; or is intended to maintain speech communication. Developmental problems including: learning difficulties such as dyslexia; autism or attention deficit disorder ADHD ; physical development problems such as short height.

Disorders of the temporomandibular joint TMJ. Treatment for obesity, or which is necessary because of obesity. This includes, but is not limited to, slimming classes, aids and drugs. We will only pay for gastric banding or gastric bypass surgery if a beneficiary: has a body mass index BMI of forty 40 or over and has been diagnosed as being morbidly obese; can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four 24 months; and has been through a psychological assessment which has confirmed that it is appropriate for them to undergo the procedure.

Treatment in nature cure clinics, health spas, nursing homes, or other facilities which are not hospitals or recognised medical treatment providers. Charges for residential stays in hospitals which are arranged wholly or partly for domestic reasons or where treatment is not required or where the hospital has effectively become the place of domicile or permanent abode.

Treatment for a related condition resulting from addictive conditions and disorders. Treatment for a related condition resulting from any kind of substance or alcohol use or misuse. Treatment needed because of, or relating to, male or female birth control, including but not limited to: surgical contraception, namely: vasectomy, sterilisation or implants; non surgical contraception, namely: pills or condoms; family planning, namely: meeting a doctor to discuss becoming pregnant or contraception.

Treatment relating to infertility other than investigation to the point of diagnosis , fertility treatment of any sort, or treatment of complications arising as a result of such treatment. We will pay for investigations into the cause of infertility if: the specialist wishes to rule out any medical cause; the beneficiary has been covered under this policy for two 2 consecutive years before the investigations have commenced; and the beneficiary was unaware of the existence of any infertility problem, and had not suffered any symptoms, when their cover under this policy commenced.

We will not pay maternity benefits: to a beneficiary who acts as a surrogate; or to anyone else acting as a surrogate for a beneficiary. These children can only join once they are ninety 90 days old, and will be subject to medical underwriting. Nursery care for a newborn in hospital, unless the mother is required to remain in hospital due to medical necessity for treatment that is covered by this policy. Preventative treatment, including but not limited to health screening, routine health checks and vaccinations unless that treatment is available under one of the options for which a beneficiary has cover.

We will pay for preventative surgery when a beneficiary: has a significant family history of a disease which is part of a hereditary cancer syndrome such as ovarian cancer ; and has undergone genetic testing which has established the presence of a hereditary cancer syndrome.

Please note that we will not pay for the genetic testing. Under the International Medical Insurance plan, the limits of cover for preventative surgery in respect of congenital conditions will apply, other than for cancer. Treatment for sexual dysfunction disorders such as impotence or other sexual problems regardless of the underlying cause.

Treatment in the USA, unless the beneficiary has purchased Worldwide including USA cover under this policy, or the treatment can be covered under the Out of Area Emergency cover conditions. Treatment in the USA where the Worldwide including USA cover was purchased if we know or reasonably suspect that the cover was purchased and the beneficiary travelled to the USA for the purpose of receiving treatment.

Treatment which is intended to change the refraction of one or both eyes, including but not limited to laser treatment, refractive keratotomy and photorefractive keratectomy. We will pay for treatment to correct or restore eyesight if it is needed as a result of a disease, illness or injury such as cataracts or a detached retina. Any treatment outside your selected area of coverage, unless the treatment can be covered under the Out of Area Emergency cover conditions.

Travel costs for treatment including any fares such as taxis or buses, unless otherwise specified, and expenses such as petrol or parking fees. Any expenses for international emergency services which were not approved in advance by the medical assistance service, where applicable. Cigna offers its members access to a list of providers in its network who are trained as speech therapists and can help people with autism develop effective communication skills.

Speech therapy is a type of treatment that can be used to help individuals with autism communicate more effectively with others. This is often done through the use of specialized speech-language pathologists SLPs who work with patients on developing strategies for communicating with their peers and family members.

Speech therapy is one way to help people who have autism build better relationships with others and be able to communicate their needs more easily. Speech therapy is a service that is covered by Cigna, provided that you have a policy that includes coverage for speech therapy and the other conditions speech therapy addresses. Each policy is different, and the specific conditions it covers vary according to the provider.

Speech therapy is a service provided by a professional, such as a licensed speech-language pathologist SLP , to help people with communication disorders. Speech therapists often work with people who have problems expressing themselves through speech or understanding language. They also help people who have difficulty swallowing or eating because of physical problems affecting their oral motor skills such as from a stroke , as well as children with developmental disabilities like autism.

They may also work with people who are deaf or hard of hearing and need an interpreter in order to communicate effectively with others. Some SLPs have specialty training in working with children with learning disabilities, those who have trouble reading and writing, or those suffering from the effects of brain injuries.

Speech therapy is a type of treatment in which a person works with a trained professional to improve skills related to communication and swallowing.