Billing and Insurance Policies

The UA Speech and Hearing Center is a fee-for-service clinic. All clients are expected to pay for speech-language evaluation and treatment services and audiology services. Speech-Language and Audiology services may be paid for by check, cash or credit card. These services are provided by or under the direct supervision of certified speech-language pathologists and audiologists.

SPEECH-LANGUAGE EVALUATION AND TREATMENT SERVICES

Private Insurance

Blue Cross Blue Shield (BCBS) insurance will be billed for speech-language evaluation and treatment services if a client has a doctor referral for the services being requested. No other private insurance companies area accepted at this time. Not all BCBS policies cover our services. It is the client’s responsibility to be familiar with their benefits.

Medicaid

Medicaid will be billed for speech language services on behalf of clients under the age of 21 who have an active Medicaid number. Medicaid clients under age 21 must have a Medicaid referral form (EPSDT) from their primary care physician on file in the clinic prior to services being provided. Medicaid referrals can be faxed to us by the client’s physician or brought by the client on the day of scheduled service.

Medicaid will be billed for speech-language services for clients ages 21 and older who have QMB Medicaid. Clients must still  have a doctor referral for the services being requested but an EPSDT form is not required. Medicaid does not cover speech-language services for clients ages 21 and older who DO NOT have the QMB policy.

Medicare

Medicare will be billed for Speech-Language services that (1) are not considered routine and (2) considered by Medicare will be to medically reasonable and necessary. Services may be billed directly to a Medicare beneficiary if: (1) the service is statutorily excluded or (2) the Medicare beneficiary voluntarily requests Medicare not to be billed for a covered service and an ABN is completed.

Private Pay

Clients who are uninsured, have an insurance provider not accepted by our clinic, whose BCBS policy does not cover our services, whose allowed insurance benefits have expired, who are enrolled in a flat-fee program, or who are a UA student are classified and private pay clients. All private-pay clients are billed for the services based on the clinic’s established standard fee schedule for speech-language services.

Group Treatment Services with Flat Fees

Some group treatment services with flat program fees are not eligible for reimbursement through BCBS, Medicaid or Medicare. All clients choosing to participate in these group programs are responsible for paying for the program in-full on the first day of services for the semester.

Clients Receiving Home Health Services

Clients receiving home health services for any reason cannot be seen at the Speech and Hearing Center until they are discharged from the home health agency. This discharge status will be verified by the Speech and Hearing Center.

AUDIOLOGY SERVICES

Private Insurance

Private insurance will not be billed for audiology services with the exception of All Kids.

Medicare

Medicare will be billed for Audiology services that (1) have a physician referral on file, (2) are not considered routine, and (3) considered by Medicare to be medically reasonable and necessary. Services may be billed directly to a Medicare beneficiary if (1) the service is statutorily excluded or (2) the Medicare beneficiary voluntarily requests Medicare not be billed for a covered service and an ABN is completed. Statutorily excluded services include: hearing aids, hearing evaluations for the purpose of fitting hearing aids, and services for which the client does not have a physician referral.

Medicaid

Medicaid will pay for services and hearing aids provided by an audiologist until the client is 21 years of age. Therefore, Medicaid claims may be billed for audiology services on behalf of clients under the age of 21 who have an active Medicaid number. All Medicaid clients must have a valid Medicaid referral form (EPSDT) from their primary care physician on file in the clinic prior to services being provided. Medicaid referrals can be faxed to us by the client’s physician or brought in by the client on the day of the scheduled service.

Private Pay

Clients who are uninsured, have an insurance provider not accepted by our clinic, whose BCBS policy does not cover our services, whose allowed insurance benefits have expired, or who are a UA student are classified as private pay clients. All private-pay clients are billed for services based on the clinic’s established standard fee schedule for audiology services.