Steps for Obtaining a Speech-Generating Device (SGD)

Step 1: Device Trial 

Consult with the speech therapist to determine if a speech generating device (SGD) may be beneficial for your child. A trial period with a device in sessions or at home may be arranged to assess its potential impact. If determined to be beneficial, we will schedule your child for an AAC evaluation.

Step 2: Scheduling the Evaluation 

Once a referral is received, we’ll call you to schedule the evaluation. Depending on your child’s needs, we may coordinate for a representative from a SGD device company to join the evaluation to bring various devices and accessories to trial. 

Step 3: Complete Paperwork 

You will be asked to complete a client information packet prior to the evaluation. If going through insurance, you will also need to provide a copy of your insurance card. You may want to call your insurance company to inquire about your SGD benefits ahead of time (ask for our list of questions to ask your insurance company).

• Are there covered benefits for a speech generating device (SGD?) 

• Are the following HCPCS equipment codes covered?

• E2510 (Speech generating device) 

• E2512 (Mounting system for device, if needed) 

• E2599 (Accessories for device, if needed) 

• Would I have any copay, coinsurance, or out-of-pocket costs for any of these procedures or equipment? If so, what is the cost or percentage? 

• Is there a lifetime maximum or payment cap?

• Are there any restrictions or exclusions on this plan for the child’s diagnosis? (if child has a diagnosis, such as autism) 

• (*Only ask if the child has previously had a device funded through insurance) Is the child eligible for a new device yet, or do you only allow one device every so many years? When will he/she be eligible for a new device?

Step 4: The Evaluation 

During the evaluation, the therapist will assess the child’s communication skills, cognitive abilities, language learning style, motor skills, and sensory abilities to identify the most suitable device. Several devices and communication software options will be trialed.

Please note that we do not bill your insurance company directly for the AAC evaluation, and the cost of the evaluation will be the responsibility of the family, due on the day of service. We will, however, submit the evaluation report and all necessary documentation to your insurance company to outline the medical necessity for a speech-generating device. The insurance company will then determine if the device will be covered. If coverage is denied, you may choose to either purchase the device out of pocket or decide not to proceed with obtaining one.

Step 5: Evaluation Report 

If a device is recommended, the therapist will write an evaluation report detailing the recommended device, software, and accessories. You can use this report to privately purchase the device, or the SLP can submit the evaluation to your insurance company to see if insurance will cover the cost of the device.

Step 6: Doctor’s Certification of Medical Necessity (If seeking insurance coverage for the SGD)

The evaluation report will be sent to the child’s doctor. If they agree the device is medically necessary, they will sign a Certificate of Medical Necessity. This will be submitted to the device company and insurance for review. Please note that you may need to schedule an appointment with your child's pediatrician within 6 months of the evaluation to discuss the need for a SGD with the doctor. 

Step 7: Insurance Review and Approval (If seeking insurance coverage for the SGD)

This step may take several weeks or even months. The device company will verify all necessary information and submit it to your insurance. Insurance will determine coverage and any out-of-pocket costs. If not fully covered, you’ll have the option to pay the difference or not proceed with the device. You will not be automatically charged. If your funding source denies or defers the device, you may work with funding specialists from the device company to submit an appeal addressing the reason for the denial. 

Step 8: Device Shipment 

Once approved, the device will be shipped to the shipping address you provided in the initial paperwork packet. 

Step 9: Setup and Training 

After receiving the device, you can set it up and begin using it. Training sessions can be scheduled with an SLP at Thriveable, or a representative from the device company if desired to learn how to program and use the device.