Paramedical Providers
Speech Therapy
What is covered?
- 100% of the reasonable and customary (R&C) limit, up to $1,100 every calendar year (January 1 to December 31)
What is not covered?
Ineligible services:
- Charges for follow-up hearing aid tests
- Additional assessment tools
- Supplies, such as handbooks or tapes
- Insurance form completion charges
- Charges for copies of reports
- Missed appointment charges
Eligible practitioners
- Speech Language Pathologist
- Speech Therapist
A doctor's note or prescription is required to be eligible for speech therapy.
Ask your provider if they can submit your claim directly to GreenShield to minimize your out-of-pocket costs at your appointment.
Reasonable and customary (R&C) limit for speech therapy
To ensure members are not overcharged, every year GreenShield sets a reasonable and customary (R&C) limit for the cost of a visit for speech therapy. Every time you visit a speech therapy practitioner, the R&C limit is applied.
However…
Some providers charge more than the R&C limit.
And…
The R&C limit is the maximum amount your plan will cover for speech therapy.
That means…
If your provider charges more than the R&C limit, you will have to pay the remaining amount out of your own pocket.
You can check your eligibility and coverage limits by logging in to your account at greenshield.ca, emailing GreenShield at customer.service@greenshield.ca or by calling GreenShield at 1-877-266-5494 to use their interactive voice system. You will then see if your estimated payments are fully covered or not.
For Example:
Eleanor’s speech therapist charges $250 for each appointment. The R&C limit at the time for this service is $220, which is the maximum amount your plan will pay.
Since Eleanor will be $30 out of pocket, she has two choices:
- Pay the remaining $30 out of pocket; OR
- Use her Health Care Spending Account (HCSA) to help cover her cost—in full or in part.
Your coverage maximum resets every year on January 1.
If you reach the speech therapy plan maximum partway through the year, the full coverage amount will again be available to you on January 1.
For Example:
Tim’s wife, Bonnie, was referred to a Speech Therapist and a Speech Language Pathologist after surviving a stroke last year. Last year, Tim submitted these claims for Bonnie:
Tim reached the annual maximum at the end of July. He then had three choices:
- Continue to schedule Bonnie’s speech therapy appointments and pay out of pocket for the remainder of the year (until December 31); OR
- Continue to schedule Bonnie’s speech therapy appointments and use his Health Care Spending Account (HCSA) to help cover his cost—in full or in part; OR
- Wait until his coverage maximum refreshes on January 1, and begin Bonnie’s speech therapy sessions again.
