Our insurer denied my daughter's speech therapy. They said it's educational, not medically necessary.
We have a referral from her pediatrician and a recent evaluation that shows a clear speech delay. She needs help now, not just whatever school might offer later (and that varies by state).
Has anyone been through a speech therapy denied by insurance situation like this? Did an appeal work? What did you send, and how long did it take?
Top answer, from Sam K.
Read the full answerYes, you can appeal a speech therapy insurance denial. I've done it. Gather the denial letter, your plan's coverage criteria, the speech evaluation, and a letter of medical necessity from your child's clinician. Your appeal should respond to each denial reason and explain why school therapy does not replace medically necessary treatment. Start with the denial letter and note the exact reason they…
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Yes, you can appeal a speech therapy insurance denial. I've done it. Gather the denial letter, your plan's coverage criteria, the speech evaluation, and a letter of medical necessity from your child's clinician. Your appeal should respond to each denial reason and explain why school therapy does not replace medically necessary treatment.
Start with the denial letter and note the exact reason they gave. Pull your plan's medical necessity criteria (usually in the benefit booklet or provider manual). Get the speech evaluation on file and ask the referring clinician for a letter of medical necessity that ties the delay to specific treatment goals.
The appeals that work answer the insurer point by point: why therapy is medically necessary, what diagnosis or delay supports it, what goals you're treating, and why school-based services are not a substitute. File before the deadline and send everything certified or through the insurer's portal so you have a timestamp.
Keep a simple call log with dates, names, and reference numbers. If the internal appeal fails, ask about external or independent review. That step has its own deadlines too.
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