The insurance company approved my daughter for more therapy sessions! I'm SO happy!
Hi everyone,
I was looking for info online when I stumbled across this forum. I have a 4 year old daughter that was diagnosed with PDD-NOS. She has been recieving speech therapy for 3 months, 3x's a week. Before she started the speech therapy she was pretty much non-verbal. She used a lot of gestures and grunts to communicate. Today she is capable of putting together 3 word sentences.
My issue is this, my health insurance (Humana POS) only allows 60 speech therapy visits per calendar year. My daughter has about 10 visits left. I was told by the insurance company to have her pediatrition make a referal for more sessions, and hope it is authorized. What do I do if the insurance company doesn't authorize more speech therapy sessions? My daughter needs speech therapy. Does my daughter have any legal rights in a situation like this?
Just as a side note, my daughter is going to start pre-k this fall where she will recieve therapy.
I appreciate any advice! Thanks
My daughter had a speech evaluation on Wednesday from the school district for pre-k placement and is supposed to get a pyschoeducational evaluation soon aswell. I was told based on her speech evaluation and her diagnosis alone that she qualify's for the extra help she needs, but pre-k doesn't start until August. She is recieving occupational therapy for sensory issues, but I'm afraid she may lose that too when the insurance benefits run-out.From the day of your request for the eval to the day the services she needs MUST be in place can be no longer than 60 CALENDAR days. Count back to when you requested the eval from the SD. Ask for compensatory services once your child is classified if the services can't start until after that timeframe.
Since your daughter is 4, she should be getting services through your school district. Call them immediately and ask for a full evaluation for special education services. Put your request in writing and say that they should considere the letter your written permission to evaluate. That is important because from that date to the date your daughter gets services provided for free by your District can be no more than 60 days. Your daughter most likely should have more than just speech therapy. Even being with peers on a regular basis will help. Insurance is insurance. If there is a limit to the number of visits per year, when you've used up the benefits, you'll have to wait until next year to get more. Autism doesn't guarantee MORE benefits than any other issue.
Is she eligable for medicaid?
Also, she will get services in school as Tzoya says, but likely not 3 times per week. Helpful if you can get some after-school therapy in addition to what she receives in school.
If you will not qualify for additional services outside school based on your income try for a medicaid waiver. Since your child is doing well with speech therapy, I would try everything to let the speech therapy not be interrupted.
Concernedpa.
In NYS autism kids are guaranteed daily language therapy. Other states, you have to show a need, like everything else. If your cild is not making measurable progress at the current levels of intervention, the remedy is more frequency and/or more intensity. This is just general advice. you can look for places that have schorlship or sling scales . The best of luck also your mhmr will give service to