Speech Therapy Benefits. Benefits are provided for medically necessary outpatient Speech Therapy services when ordered by a Physician and provided by a licensed speech therapist/pathologist, or other appropriately licensed or certified Health Care Provider pur- suant to a written treatment plan to correct or improve (1) a communication impairment; (2) a swallowing disorder; (3) an expressive or receptive language disorder; or (4) an abnormal delay in speech development. Continued Outpatient Benefits will be provided as long as treatment is Medically Necessary, pursuant to the treatment plan and likely to result in clinically significant progress as measured by objective and standardized tests. The provider's treatment plan and records may be reviewed periodically for Medical Necessity. Except as specified above and as stated under the Home Health Care Benefits and Hospice Program Benefits sections no benefits are provided for Speech Therapy, speech correc- tion, or speech pathology Services. Note: See the Home Health Care Benefits section for infor- mation on coverage for Speech Therapy Services rendered in the home. See the Inpatient Services for Treatment of Illness or Injury section for information on Inpatient Benefits and the Hospice Program Services section.
Speech Therapy Benefits. Outpatient Benefits for Speech Therapy Services when diag- nosed and ordered by a Physician and provided by an appro- priately licensed speech therapist, pursuant to a written treat- ment plan for an appropriate time to: (1) correct or improve the speech abnormality, or (2) evaluate the effectiveness of treatment, and when rendered in the Provider’s office or Out- patient department of a Hospital. Services are provided for the correction of, or clinically signif- icant improvement of, speech abnormalities that are the likely result of a diagnosed and identifiable medical condition, ill- ness, or injury to the nervous system or to the vocal, swallow- ing, or auditory organs, and to Members diagnosed with Men- tal Health Conditions. Continued Outpatient Benefits will be provided for Medically Necessary Services as long as continued treatment is Medical- ly Necessary, pursuant to the treatment plan, and likely to result in clinically significant progress as measured by objec- tive and standardized tests. The Provider’s treatment plan and records will be reviewed periodically. When continued treat- ment is not Medically Necessary pursuant to the treatment plan, not likely to result in additional clinically significant improvement, or no longer requires skilled services of a li- censed speech therapist, the Member will be notified of this determination and benefits will not be provided for services rendered after the date of written notification. Except as specified above and as stated under Home Health Care Benefits, no Outpatient Benefits are provided for Speech Therapy, speech correction, or speech pathology services. Note: See Home Health Care Benefits in the Plan Benefits section for information on coverage for Speech Therapy Ser- vices rendered in the home, including visit limits. See Hospi- tal Benefits (Facility Services) in the Plan Benefits section for information on Inpatient Benefits and Hospice Program Bene- fits in the Plan Benefits section for hospice program Services.
Speech Therapy Benefits. Benefits are provided for medically necessary outpatient Speech Therapy services when ordered by a Physician and provided by a licensed speech therapist/pathologist, or other appropriately licensed or certified Health Care Provider pur- suant to a written treatment plan to correct or improve (1) a communication impairment; (2) a swallowing disorder; (3) an expressive or receptive language disorder; or (4) an abnormal delay in speech development. Continued Outpatient Benefits will be provided as long as treatment is Medically Necessary, pursuant to the treatment plan, is likely to result in clinically significant progress as measured by objective and standardized tests. The provider's treatment plan and records may be reviewed periodically for Medical Necessity. Except as specified above and as stated under the Home Health Care Benefits, and Hospice Program Services sec- tions, no Outpatient benefits are provided for Speech Thera- py, speech correction, or speech pathology Services. Note: See the Home Health Care Benefits section for infor- mation on coverage for Speech Therapy Services rendered in the home. See the Inpatient Services for Treatment of Illness or Injury for information on Inpatient Benefits and the Hos- pice Program Services section. See the Inpatient Services for Treatment of Illness or Injury section for information on Inpatient Benefits and the Hospice Program Services section.
Speech Therapy Benefits. Benefits are provided for medically necessary outpatient Speech Therapy services when ordered by a Physician and provided by a licensed speech therapist/pathologist, or other appropriately licensed or certified Health Care Provider, pursuant to a written treatment plan to correct or improve
Speech Therapy Benefits. Benefits are provided, only when referred by Member's Participating Primary Physician, by means of a prior written referral, in and by Participating Providers as follows:
