Myofunctional therapy is an increasingly utilized form of physical therapy that focuses on the muscles of the mouth, face, and neck. The purpose of myofunctional therapy is to correct breathing, speech, and swallowing issues. Patients of all ages can benefit from it, though it is most effective for children because they are still growing and developing.
If you or your child is in need of myofunctional therapy, you may be wondering if it is covered by insurance. The answer is that it depends on a few factors such as your plan, diagnosis, and provider. Marvel Myo & Speech is here to help you navigate the ins and outs of insurance coverage for myofunctional therapy so you can get the most out of your benefits.
What is Myofunctional Therapy?
For those with speech, breathing, and swallowing challenges, myofunctional therapy involves exercises that train the muscles of the mouth, face, and neck to move properly. As patients practice these exercises, both with a therapist and on a daily basis between therapy sessions, these movements become automatic, providing long term solutions.
Myofunctional therapy can be used to treat the following:
- Tongue-thrusting. This habit causes improper development of the upper jaw and results in swallowing issues.
- Sleep disordered breathing. Breathing issues during sleep, such as sleep apnea, prevent patients from getting quality sleep.
- Speech issues. Incorrect pronunciation of certain sounds and words can affect communication and social acceptance.
- TMJ disorder. Pain and tension in the jaw are the main symptoms associated with TMJ disorder.
Benefits of Myofunctional Therapy
Myofunctional therapy offers a variety of benefits, including:
- Clarified speech. Delays in speech or mispronunciation can cause communication issues that affect daily interactions. Myofunctional therapy can correct these issues, helping patients communicate effectively and eliminate barriers.
- Improved eating capabilities. Proper swallowing technique is necessary to prevent choking or asphyxiation when eating. Myofunctional therapy can help patients get necessary nutrition without complications.
- Better sleep. Sleep disordered breathing can prevent patients from getting restful sleep, which can lead to a variety of health issues. Myofunctional therapy can provide a long term solution without the use of a CPAP or oral appliance in some cases.
Why Insurance Coverage for Myofunctional Therapy Varies
When it comes to insurance for myofunctional therapy, the coverage varies based on a wide range of factors.
- Medical vs Dental Insurance. Most medical insurance plans don’t cover myofunctional therapy, but some dental plans do depending on the cause and treatment.
- Diagnosis. The diagnosis will also determine coverage. Myofunctional therapy for conditions such as TMJ disorder may qualify for insurance coverage.
- Medicaid. In some states Medicaid covers myofunctional therapy for speech or swallowing disorders, especially in children.
- Orthodontic Treatment. If myofunctional therapy serves an orthodontic purpose, dental insurance may cover it.
How to Check if Your Insurance Covers Myofunctional Therapy
Here is a step-by-step guide to help you check for insurance coverage in your case:
- Review your insurance policy for speech or oral motor therapy coverage.
- Ask your provider for specific billing codes.
- Contact your insurance company to confirm eligibility.
- Keep written documentation of all communications.
Marvel Myo and Speech can assist patients in verifying benefits and submitting claims. We want to help you make the most of your insurance coverage to make myofunctional therapy as affordable as possible.
Alternative Options When Insurance Doesn’t Cover Treatment
- Health Savings Accounts (HSA). If your insurance plan includes an HSA, those funds are eligible to use for myofunctional therapy.
- Flexible Spending Accounts (FSA). Insurance plans that include FSA accounts can also be used for myofunctional therapy.
- Medical Financing. There are a variety of medical financing options to make out of pocket medical costs more affordable, offering little or no interest and monthly payments.
Marvel Myo and Speech Offers Assistance
We believe that myofunctional therapy should be available to anyone who needs it, which is why we offer the following discounts:
- 50% off with income less than 30,000
- 40% off with income 30,000-50,000
- 30% off with income 50,000-75,000
- 20% off with income above 75,000
Our evaluations are currently $450 for the initial screening and diagnosis. Session rate is $85 a session. We are happy to help you navigate your insurance and submit claims for reimbursement. Contact us today to schedule your consultation.
Frequently Asked Questions About Myofunctional Therapy and Insuranc
Does my medical insurance cover myofunctional therapy?
Coverage depends on your diagnosis and insurance plan. Some medical and dental policies may cover sessions under specific codes.
What can I do if my insurance denies my claim?
You can appeal the decision with supporting documentation from your therapist. Marvel Myo and Speech can help you understand your options.
Marvel Myo and Speech provides virtual myofunctional therapy services nationwide. We reach underserved areas by offering online therapy sessions you can attend from the comfort of your own home. Our services have helped patients across the US improve speech, swallowing, and breathing for long term results. Contact us today to learn more and schedule a consultation.
