Speech therapy services can sometimes be a combined benefit under an HMO/POS member’s short-term rehabilitation therapy benefits. For members of our Medicare HMO Blue Plan only, we require authorization for the initial 30 visits.
When a patient needs speech therapy, their primary care provider (PCP) or an authorized specialist is responsible for generating an auto-approved initial authorization for the first 30 visits, every 365 days.
|An authorized specialist is a specialist who has an open referral from the member's PCP or is in the PCP's referral circle.|
To do this, the PCP or specialist will need to use a technology. If the member’s maximum visits have already been met for the 365-day authorization period, a message will be displayed.
Technologies you can use to submit your request
For members of the Federal Employee Health Benefit Program, call Provider Service at 1-800-451-8124.
|The speech therapist determines that care beyond the initial 30 visits is needed||
|The member has a new episode of care within the same 365-day period and the first 30 visits have been used||
The authorization decision will be based on medical necessity criteria.
To learn the status of an authorization, you can: