Our Outpatient Office is located at 1303 Limit Ave, Ste 201, Mount Dora, FL 32757. We are just 5 minutes from downtown Mount Dora. We also offer mobile therapy services, which means our therapists can drive to your home for your appointments with us. We are currently covering areas within most of Lake County, FL and also parts of the Villages and Wildwood in Sumter County. Availability for our mobile services can be limited, so please call to see if we can accommodate you.
WHAT CAN I EXPECT IN MY SESSIONS?
The initial evaluation usually takes 45-60 minutes and allows the clinician to gather the necessary information to create your unique treatment plan. During our treatment sessions you will be provided with skilled instruction, education and exercises for your impairment. Treatment sessions are typically 30 minutes depending on your needs. After each session you will be given home exercises to work on until the next session.
HOW LONG CAN I EXPECT TO WORK WITH YOU?
This varies greatly depending on your complex situation. Most plan of cares are anywhere from 1 to 3 months in duration, with visits anywhere from 2 to 4 days a week. It truly depends on you and your needs. We do have patients that need ongoing therapy and we see them on a yearly basis as needed with occasional breaks being taken on a home exercise program. Our goal is to maximize your recovery and allow you to continue independently within a home exercise program as quickly as possible.
DO I NEED A REFERRAL FROM MY DOCTOR?
Yes and they can fax a referral for speech therapy services to (352) 855-0459. While a referal is not required in the state of Florida to begin services with an evaluation, it is required to have a doctor sign the plan of care to proceed with treatment. Each doctor has their own set of rules and policies for how to work with therapy providers. For this reason, we do ask for a referral before we begin services which will ensure that the doctor is in agreement for their mandatory signature on the plan of care.
WHAT IS NEEDED TO HAVE THE FEES (FLEXIBLE ENDOSCOPIC EVALUATION OF SWALLOWING) AND/OR VIDEOSTROBOSCOPY PROCEDURE?
We would need an order from one of your doctors for this service. After that, we will verify your insurance to make sure you are covered 100%. If not, we will disclose any out of pocket costs to you in writing before scheduling your exam and make sure you are in agreement with your cost. Once all the logistics are cleared, we will schedule the exam. We will email you a confirmation email with a video link of what to expect within this exam to alleviate any stress you may feel about this procedure.
WHAT RISKS ARE ASSOCIATED WITH HAVING A FEES AND/OR VIDEOSTROBOSCOPY EXAM?
Great question! We do discuss this with you in person and have you sign a consent form stating your understanding. Please be assured, this has been reported as a fairly comfortable procedure from most of our patients. Read on to understand the risks and benefits that are written on the consent form which you will sign before this procedure can begin:
Definition
A FEES exam entails passing a flexible fiberoptic endoscope through the nose to the hypopharynx (into the throat) achieving a panoramic view to the larynx and pharynx (speech and swallow anatomy). The scope remains above the level of the true vocal folds and trachea (airway) throughout the exam. A Videostroboscopy entails the same procedure, therefore can very easily be done at the same time. It only requires a change of light source for capturing the rapid movements of the vocal folds. You will be asked to perform a variety of speech tasks as part of your vocal assessment. For the FEES portion of the exam, a variety of foods and liquids will be given in order to observe swallow function and address any problems. Both exams will need to be acknowleged as necessary and appropriate by the treating SLP (Speech-Language Pathologist) and/or physician.
THE FOLLOWING ARE POSSIBLE ADVERSE REACTIONS TO FEES/VIDEOSTROBOSCOPY:
- Nosebleed
- Fainting
- Laryngospasm, which is an abrupt tightening of the vocal folds if the endoscope vigorously manipulates the true vocal folds.
- Aspiration (FEES ONLY)
- Infection Sinusitis
- Laryngitis
Benefits of FEES Exam
Patients who undergo the FEES exam may benefit from the identification of loss of airway protective reflexes as well as swallowing problems. Based on this information, recommendations will be made regarding diet modifications to prevent food and liquid from entering the airway during a swallow. Recommendations also will be made regarding areas to focus on for treatment with the SLP.
Benefits of Videostroboscopy
This exam allows to better identify any issues with voicing by capturing the movement of the vocal fold vibrations. We can then assess for structural abnormalities, recruitment or lack of recruitment with important muscles for voicing, as well as the ability of the folds to come together when speaking.
Alternatives
Alternatives to the FEES exam are the Modified Barium Swallow (MBS) study, which entails administration of foods and liquids coated with barium while undergoing video x-ray. The other alternative is the Bedside Swallow evaluation, which is mostly subjective information and performed by a Speech-Language Pathologist. It involves presentation of foods and liquids while observing for various symptoms suggestive of a swallowing problem and possible aspiration (food/liquid entering the trachea) with no visualization of the hypopharynx area. Alternatives to the Videostroboscopy is a voice evaluation without instrumentation that soley relies on acoustic and respiratory measures with no visualization of the anatomy.
WHAT INSURANCE DO YOU TAKE?
- Original Medicare plans under Part B Benefits
- Most out of network insurance plans (PPO, POS)
- Cash/Self Pay Options
Cobalt Therapy is currently a Medicare B Provider and accepts all patients under original Medicare as well as those with insurance plans that cover out of network services. While we are not a provider for Medicare Advantage (or Medicare Replacement) plans, some will make exceptions if you can not find a Speech Therapist in their network for your area.
This also reduces the chances of our company ever having a long wait list which is what can happen at outpatient centers that accept most insurance plans. If you are restricted by your current insurance, we do have cash self-pay options. Please call us so we can determine how to best help you in this area.
We do all of the billing for you and you only need to pay if you have a co-payment/co-insurance portion. The only requirement for your care to be covered by Medicare is that you can not currently be receiving speech therapy for the same services from another provider. You also can not be in a home health episode receiving benefits under your Medicare Part A benefits. That would mean that you are already getting therapy services in your home and/or nursing visits under your Medicare Part A benefits. Confusing? Yes!
Please read this article to learn more about whether you would benefit most from therapy under your Medicare Part A vs Part B benefits and why it matters: Medicare Part A Or B for Therapy?
I NEED YOUR SERVICES, BUT YOU DO NOT ACCEPT MY INSURANCE. WHAT CAN I DO?
We have worked with many patients that were in need of our specialized services (such as e-stim for dysphagia or LSVT LOUD for voice) with HMO insurance. HMO insurance basically restricts the insurance holder to only seeing providers within their network. We have found that most of these insurance plans will make exceptions if you are not able to find a provider within their network that offers the treatment you need. This is called a Network GAP Exception. Once you have obtained this exception from your insurance, we will keep a credit card on file and charge after your session has been completed. We would then provide you with what is called a superbill, and you will then submit that to your insurance for reimbursement. Please contact us for assistance with this process.
I NEED YOUR SERVICES, BUT I CAN’T AFFORD THE CO-PAYS. WHAT CAN I DO?
Many people have an insurance plan that made good economical sense at the time they chose it. Then life happened. Maybe it was a car accident or a stroke. That plan is no longer covering you in a way that is economically sound. We work with insurance specialists that can help you navigate this challenging terrain if you do not already have someone that you trust. Please contact us for assistance.