INSURANCE

1. Q: Does my insurance pay for speech therapy?

A: We are one of only a few private practices that accept insurance reimbursement. However, we do not accept all insurances. Therefore, it is in your best interest to contact your insurance company to determine if D.L. Teter Ph.D. and Associates is an in-network provider. Out-of-network benefits are sometimes available at varying rates. As a courtesy to our patients, we agree to call your insurance company to check your benefits for billing purposes. However, any unpaid balance, regardless of the reason, is ultimately your responsibility, so we strongly suggest you call your insurance company as well. You should also be aware that any quotation of benefits by your insurance company is NOT a guarantee of payment.

2. Q: What questions should I ask my insurance company about my benefits for speech therapy?

A: 1. What is my speech therapy benefit? How long is it good for?
2. Do I have in- or out-of-network coverage?
3. Do I need a referral or authorization? How do I obtain it?
4. Are there any restrictions based on my diagnosis?
5. What are the exclusions or limitations, such as does therapy need to be medically necessary or does therapy need to be restorative in nature?
6. Is pre-determination or pre-authorization required?
7. Is my plan self funded, federally funded, or state funded?

***Always get a name of whom you talked to and note the date and time. Keep this information. It can be useful if you need to submit an appeal.***

3. Q: Why is speech therapy covered for some diagnoses and not others?

A: Benefits vary depending on your policy. Often times there are restrictions and stipulations, especially for pediatrics, on what is covered and what is not. We encourage you to get things in writing and to keep an organized log of all contacts with you insurance company. Insurance rarely pays for conditions that are not medical in nature such as articulation problems. It is vital that you understand your benefits.

4 Q: Speech therapy was covered for my other child last year for the same diagnosis. Why are they denying coverage this time for the same condition?

A: Your plan and/or your employer may have changed the wording in your certificate of coverage at your renewal date (usually occurs in January). Many employers offer several plans and even if you re-enroll for the “same” plan you had before there could be changes you aren’t aware of. It is also a possibility that the other child’s claims skipped through and were paid when they shouldn’t have been. You can always appeal any denial. If you call your insurance company they can give you the steps. It is also useful to build a good relationship with your employer’s human relations department.

5 Q: I received a bill from you because my insurance company denied the claim. I had a referral/authorization, doesn’t that mean they have to pay?

A: No, not necessarily. As you may know, your insurance company states that any authorization/quotation of benefits is not a guarantee of payment. Authorization is only permission to go to a certain provider. Claims collections are easier when an authorization is in place, but it is not a guarantee. Often times, it is easier to collect payment when we receive a referral or authorization. You can request a written statement from the insurance company that outlines if your procedure is covered or not.

6 Q: Will my insurance company cover my hearing aids?

A: There are essentially no insurance plans that cover or pay for a portion of hearing aids, as Medicare doesn’t cover them. In rare instances, your plan may have a hearing aid benefit. You need to call your insurance company to check if there is a benefit before you schedule. You should also ask where you could go just in case you are limited to certain providers. Always ask if you need a referral or authorization so that you can have that done ahead of time to avoid delays.

 SPEECH
7 Q: What type of education and training is needed to be a speech language pathologist (SLP)?

A. Certified speech language pathologists (SLP’s) need to complete a Masters’ level degree from an accredited university. In addition, the national board exam must be passed as well as completing a fellowship year. The state of Colorado is one of only a few states that do not require state licensure. Some work settings do not require national certification. Our speech pathologists are certified nationally, maintain proper continuing education or are in the process of completing a fellowship year.

8 Q: What do SLP’s do?

A: Training can be in a huge variety of fields. If a person’s ability to communicate is impaired in any way, a speech pathologist is often involved. Most SLP’s tend to specialize either in pediatrics, school age or adults. Subspecialties span an even wider variety of areas. Many people have a narrow understanding of what an SLP does. For more information, visit the American Speech Language Hearing Association (ASHA) at www.asha.professional.org.

9 Q: How long will therapy take?

A: The length of therapy greatly varies. The American Speech Language Hearing Association (ASHA) is currently gathering information to better answer this question. Obviously, there are several variables to consider including an accurate diagnosis, cognitive development, motivation, family involvement, skills of a therapist, etc. We have an ongoing database and can help provide better estimates following an accurate diagnosis.

10 Q: My child has a speech delay. Does he/she need a hearing test?

A: We highly recommend that your child receive a hearing test in conjunction with a speech evaluation to rule out the possibility of a hearing loss.

11 Q: Will my child grow out of this communication problem or disorder?

A: Even in today’s world with tremendous advances in technology, medicine, and human genetic research, we still often hear the phrase “they will grow out of it.” A major indicator for speech and language or hearing problems is a parent’s concern. While folklore may support the idea of “late bloomers” or “late talkers”, we would strongly recommend that you at least be evaluated by a professional. A Speech Language Pathologist (SLP) is best to make this determination. In our opinion, waiting is a gamble not worth taking.

12 Q: What kinds of service are available for my child?

A: There are several different programs available for children depending upon age and medical need. These programs typically fall into three types of programs. For information regarding government mandated programs (preschool and school based services), go to Colorado Department of Education (www.cde.state.co.us) and search for Early Childhood Corrections for age birth to three years, search for Child Find for ages 3-5 years and Elementary, Middle School or High School for school aged individuals. Inpatient programs may be those in long term living facilities, hospitals and psychiatric homes. Out patient programs cover the remainder. Out patient programs are usually private pay. A few offices, like ours, accept third party reimbursement. We are unique in that we participate with many insurance programs and provide pediatric, adolescent and adult services.

13 Q: Why can’t I just get the same therapy in school so I don’t have to pay?

A: School based services have qualification guidelines that must be met. Many individuals with speech impairments do not qualify for school based programs. There are advantages and disadvantages to school programs. We are happy to discuss these differences with you.

14 Q: Where are you located?

A: We have five offices throughout the Denver Metro area. Please see the locations page.

 HEARING

1 Q: I have difficulty hearing. Is all hearing loss the same?

A: No. There are 3 types of hearing loss: sensorineural, conductive, and mixed.
---Sensorineural hearing loss: This means that you have permanent “damage” to the hearing nerve. There is nothing medically that can be done to repair the damage. In most cases, a hearing aid can provide benefit.
---Conductive hearing loss: This means that the hearing nerve is working properly. However, there are some problems (i.e., obstruction, medical issue) affecting your ear canal, eardrum or your middle ear. Your hearing loss may be temporary. Once the “medical condition” is treated, your hearing may return to normal limits. However, it is possible that some hearing loss may remain depending on the type and severity of the medical problem.
---Mixed hearing loss: This means that you have a permanent damage to your hearing nerve (sensorineural hearing loss), but you also have a medical problem affecting your ear canal, eardrum or middle ear (conductive hearing loss). The medical problem that is causing some hearing loss may be alleviated, but the nerve damage will remain.

2 Q: How often should I have my hearing tested?

A: Once identified with hearing loss, it is a good idea to have a hearing test done every 1-2 years or whenever you suspect you might have had a change in your hearing.

3 Q: How do I know which hearing aid is right for me?

A: Your audiologist will help you decide the proper power, size and circuitry that are right for you. A hearing aid is chosen based on your hearing loss and your specific needs. Your audiologist will ask you various questions to determine what is best for you.

4 Q: Why see an audiologist as opposed to a hearing aid dispenser?

A: Our audiologists are certified in all areas of audiology and have extensive knowledge and experience in all areas of hearing care issues.

5 Q: What are your staff’s qualifications?

A: All of our staff audiologists have Master’s degrees from accredited universities and completed a certificate of clinical competence from the American Speech/Language and Hearing Association. In addition, the audiologists also hold a State Registration Certificate in Audiology as required by state law.

6 Q: What types of hearing aid technology are available?

A: Today’s technology allows for non-programmable analog, programmable analog and programmable digital hearing aids. Programmable hearing aids are set internally (programmed) by your audiologist using a computer. Adjustments can be made in the office in just minutes. Analog hearing aids and digital hearing aids process sound somewhat differently due to the mechanics of the internal components. Digital processing may offer clearer sound quality over analog due to the internal make-up. Think of it in terms of listening to music recorded on a cassette tape versus a compact disc. Although both come through clearly, some might say a compact disc sounds less processed than tape.

7 Q: What is the difference between an in-the-ear hearing aid and a behind-the-ear hearing aid?

A: An In The-Ear (ITE) hearing aid is custom fit to your ear. Your audiologist will take an impression of your ear, and the hearing aid will be made from that impression. The ITE hearing aid is custom fit for your ear and will not fit anyone else. ITE hearing aids come in several sizes: a full shell, which is the largest ITE product all the way down to a completely in-the-canal hearing aid which is virtually undetected in the ear. Again, your audiologist will work with you to determine which size hearing aid is the most reasonable. A Behind-The-Ear (BTE) hearing aid is a larger hearing aid and it sits behind your ear. An impression will be taken of your ear for an ear mold. The ear mold will sit in your ear. Clear tubing will attach the hearing aid and the ear mold together. While the hearing aid itself is not custom made for you, the ear mold is and will sit comfortably in your ear.

8 Q: What is the difference between analog and digital aids?

A: Analog provides basic amplification. The digital is a mini computer providing better sound processing which can more closely match hearing loss.

9 Q: Are there any special options available on hearing aids?

A: Depending on the technology chosen, different options may be available. For example, some standard options on a hearing aid are a volume control and the capability of just one program. However, some hearing aids come with a remote control, which allows you to adjust the volume with the remote. A remote or push button option will allow you to have more than one memory so different listening situations can be programmed for different situations (i.e., one program for quiet situations and another program for when you are in noisy situations). Others come with an automatic volume control so you never need to adjust the volume. The hearing aid senses a change in volume and automatically adjusts the hearing aid.

10 Q: How much can I expect to pay for a hearing aid?

A: Prices very depending on the size of the hearing aid, ITE versus BTE, and the technology. Non-programmable analog hearing aids are less expensive than programmable hearing aids, which are less expensive than digital hearing aids. Adding on some of the options can also add to the cost of the hearing aid. Again, your audiologist will work with you to determine your ‘wants and needs’ in order to make your hearing aid experience pleasant and successful.

11 Q: What is included in the cost of a hearing aid?

A: The cost of a hearing aid is very comprehensive. It includes:
-The hearing aid evaluation, hearing aid fitting, orientation and follow-up services.
-It also includes the manufacture’s warranty of service and loss or damage, which may be from one to two years. A hearing aid purchase is a process, not a one-time visit. We will work with you to ensure a successful hearing aid experience.

12 Q: Will my insurance pay for hearing aids?

A: Insurance benefits vary greatly from insurance carrier to carrier and within individual policies. It is best to contact your insurance company directly to determine if you have a benefit and/or if you need a referral from your primary care physician before visiting our office.

13 Q: Why are my friend/neighbor/relative’s hearing aids different from mine?

A: Hearing aids come in different sizes, shapes, and technologies. This is why it’s important to work with an Audiologist to choose the aids that are right for you.

14 Q: I bought my hearing aid somewhere else but have a problem with it, can you repair and service it?

A: We work with most major hearing aid companies and can provide care and service for the majority of hearing aids available. If you have a specific question on a brand, call us or see locations on our Web page for the office nearest you.

15 Q: What if the hearing aid chosen for me just doesn’t work for me?

A: Hearing aids come with a 30-day trial period. During that trial period, your audiologist will want to see you at least once a week to monitor your progress. It may be necessary to make minor changes to your hearing aid, “tweaking” it, so as to shape sounds to achieve the most benefit. It may take a couple of visits to get them comfortable for you. If, by the end of the 30-day trail period and several visits you are not satisfied, your audiologist will work with you to find a hearing aid that is successful for you. If you are not satisfied, you will get you money refunded minus the fitting cost.

16 Q: Do hearing aids have any warranty?

A: Most hearing aids have a one-year warranty to cover repairs and accidental damage or loss through the manufacturer. There may be a deductible or co-pay for the loss of a hearing aid under warranty. Often the premium digital hearing aids have a two-year warranty. The warranty information must be on the contract, as required by state law.

17 Q: Do digital hearing aids last longer than older, conventional hearing aids?

A: All hearing aids have a life span of about five to seven years. The life span is not dependent on the technology in the hearing aid but on the care of the aid. The most common cause of failure with hearing aids is wax. Diligent and cautious cleaning of the hearing aid on a daily basis will prolong the life of the hearing aid and reduce repairs.

18 Q: How long do hearing aid batteries last?

A: Typically, a battery will last about one week. However, the battery life for some smaller aids may only be 5 to 7 days while behind-the-ear hearing aids may last 10 days to 2 weeks. The rule of thumb is: the smaller the battery, the shorter the life and the more power a hearing aid requires the more battery drain.

19 Q: What is a hearing consult?

A: A complete hearing evaluation tests your ability to hear a variety of tones as well as your ability to discriminate speech. This information is necessary to evaluate and select appropriate hearing aids. The audiologist will also ask many questions about your daily listening situations.

20 Q: Do I wear my hearing aid all day and all night, do I sleep with it in?

A: Hearing aids, by design, are to be worn during your waking hours, much like eyeglasses. Benefits from hearing aids are increased when the hearing aid is worn on a consistent and daily basis.

21 Q: Will insurance cover swim molds?

A: Swim molds are used for children and adults that have had tubes placed in their eardrums. Due to this surgery it is important to keep water out of the ear. Swim molds are custom plugs fitted to an individual’s ear and will keep water from getting into the ear canal. A few insurance companies have covered the custom plugs with a physician’s prescription.