Insurance will NOT cover!!!Our ins. won't cover "developmental" therapies since we're already getting a "discount" through Babies Can't Wait, we still pay about $600 a month out of pocket but it would be more like $1800 a month for therapies w/out the EI "discount." Even if we weren't using the state EI, our ins. would only give us 60 visits a year and we would have to pay a $40 copay for each session! We found that ins. was all too happy to pay for the eval and dx process and all the testing, MRI, etc. I guess they don't mind when you get a dx, they just don't want to do anything to pay for treatment AFTER the dx. We are waiting on a decision from Katie Beckett Deeming Waiver (you may want to check into that) but we're not getting our hopes up as we have heard they are denying a lot of people lately. In the meantim, we're resigned to the fact that we will probably just have to suck it up and try to budget in other areas. Bonnie thats just weird. We live in central Florida and Matthew got all his before age 3 evaluations from early intervention. They did this for free. Our insurance doesn't cover any therapies either. As far as I know no insurance does cover for autism. You don't even want me to get started on that, it makes me so angry Ruth Ruth, the Early Steps program here in Florida told me they don't do evaluations... Stacy, I am sorry. I am waiting the day when I discover our ins (BlueCross/Blue Shield) wont cover something. They don't do therepies or DD either.... http://www.nichcy.org/pubs/parent/pa2txt.htm (IN PART) Where do I go for help?There are a number of ways you can find help for your child. Since you are reading this Parent’s Guide, we recommend that you look on the NICHCY State Resource Sheet for your state under the heading “Programs for Infants and Toddlers: Birth Through 2.” There, we have listed the main contact number for early intervention services in your state. Call the agency listed. Explain that you want to find out about early intervention services for your child. Ask for the name of a contact person in your area.
It is very important to write down the names and phone numbers of everyone you talk to. (You can use the Parent's Record-Keeping Worksheet near the end of this publication as a guide.) Having this information available will be helpful to you later on. What do I say to the early intervention contact person?Explain that you are concerned about your child’s development. Say that you think your child may need early intervention services. Explain that you would like to have your child evaluated under IDEA. Write down any information the contact person gives you. What happens next?Once you are in contact with the early intervention system, the system will assign someone to work with you and your child through the evaluation and assessment process. This person will be your temporary service coordinator. He or she should have a background in early childhood development and ways to help young children who may have developmental delays. The service coordinator should also know the policies for early intervention programs and services in your state.
Also check out http://www.autism-pdd.net/resources-by-state.html for a complete list of states so you can find your states Early Intervention program Have you tried early intervention? That is where we went when we suspected our son was autistic. This is a FREE service. And they do so much more than just diagnose. Here is a website that gives some facts about it: http://www1.dshs.wa.gov/iteip/ hope it helps, Ruth I just took another look at the website I posted above and it is only for Washington. However we live in Florida and have an early intervention program and I believe most if not all states have one. Thanks for the help guys! Actually early intervention has been visiting Brock for the past 7 months. The speech therapist, a special ed. teacher,and an autism resource teacher see him a total of 7 times a month combined. They have been great to work with and have told me Brock meets the criteria to qualify for their services even if he doesn't have a diagnosis. They evaluate his progress every 6 months and determine if he continues to qualify for services. He is eligible until he is 3 at which time I think he will need to attend the special needs pre-school here in our district.I still NEED to know (even though I think I already know-you know?) Plus, how is he going to be able to qualify for any other type of services without a diagnosis? ( I can already feel a tail-chase coming on!)I called the child health specialty clinic today and informed them of what is going on. I told them to keep Brock's appt. and I'll pay out of pocket for it(I may need to start my own 900 number to fund this project! )I'm just so frustrated at that #$%*@%! insurance company! Of all things to not cover! Like we might abuse our coverage and go to therapies for sh$%& and grins!  I suppose they need to cover their tail ends somehow-especially with autism on the rise. We're just discovering that our ins won't pay for Luke's speech therapy. 
Our dev ped gave him a medical dx along with the autism so that he
WOULD be covered for everything. They covered maybe 3 speech
visits (at 60% reimbursement) and that's it. The thing that
stinks is that his biggest issue is speech!! As if speech therapy
is a luxury -- like our kids don't need to learn how to
communicate. GRRRRR!You know, I keep wishing that somehow we parents of autistic children could form a huge class action suit against our ins companies and FORCE them to pay for our kids' therapies. I wish I knew a good lawyer!! (Or even a very hungry ambulance chaser  ... I wouldn't be picky!)Stacy, EI coevers evaluations here and if I am not really wrong (which I often am) they do everywhere. Now they may not go where you want to go, but they will pay to have your child evlauated. Call your coordinator and tell him / her that the Dr wanted to reassess your child, with us, our coordinator took it from there and scheduled the intensive eval with the team at our local university. We had a choice of 3 places, but they payed it all. Our HMO was the same way, they wouldnt even pay to have DS's hearing tested, until we got the dx. WOW I need to call our service coordinator, I guess. I wonder how much they don't tell you....They did evaluate her for their services but said they don't do diagnosis.. I was planning to take JadenGrace next week and pay out of pocket. (praying ins will cover this one, though) But if EI is supposed to pay for evaluation, I could save the $25 co-pay plus 20 percent of the bill ! I am calling her today... Stacy, Our insurance dosen't cover autism either since it falls under a dd. My son's ped. used a differnt dx code for his O.T, P.T, and S.T so the insurance would cover those services. Early intervention was great, they did evaluated my son but not for a dx. They did an evaluation to see what services he needed and what services we as a family needed. After all the evaluations at age 2 1/2 he went to a local school for mr/dd children three days a week for a couple hrs and parents were expected to stay to learn intervention for there child. He also went to S.T twice a week, O.T once a week at a children's hospital. At age 3 he started pre-K at the same school were he received S.T, O.T, and P.T. He stayed there for 3 yrs and just stopped going to the hospital for O.T about a year ago which he is 10 now. He no longer needs S.T and his S.I will always be an issue but things are getting better. Eary intervention is the key, so get all the services you can, talk with the ped. maybe he or she will do the same for your child. There is also a program for children and it will cover any dx testing that a Docter might order. My son ped. filled out the paper work and it covered the cat scan, eeg, and mri he order before he dx my son. I think it was called BCI, I'm sorry but it was 7 years ago. Bonnie, RU in Fl?Check pg 40 of this site http://www.cms-kids.com/esproviders/training/module1/lesson2 /ESpolicy.htm Service Delivery Policy and Guidance Other Services The IFSP must include, to the extent appropriate, any medical, health and other services that the child needs, or family needs related to enhancing the development of the child, but that are not required under Part C. The IFSP must identify any of these services needed by the child and family and the funding sources to pay for the services or the steps that will be taken to secure those services through public and private sources (34 CFR §303.344(e)(i). Including such services provides a comprehensive picture of the child's total service needs. In addition, service coordinators will assist families, as needed, in gaining access not only to early intervention services, but to the other services identified in the IFSP, and will coordinate the provision of these services (34 CFR §303.23 (a)(3) and note following §303.344). • Information, resources, training, and support relative to providing services in everyday routines, activities and places are made available to the family by the team. • Families have knowledge and understanding of a consultative team approach in the provision of supports and services in everyday routines, activities and places and their role on the team. • The team is respectful of the family’s culture and values their input and opinions as team members. • Services are provided utilizing the team members involved in the assessment and development of the IFSP. Now-someone-correct me if I'm wrong-isn't autism a medical disorder and not a developemental disorder? I called my insur. co. to get a bit more info from them. I reminded them that Brock has not been diagnosed with autism just lang. delays. I asked what services, if any, they would cover if autism ended up being Brock's diagnosis. She said she was not able to tell me whether anything would be covered as far as that diagnosis went-we would have to call for eligebility and just wait and see.(Wait and see is becoming a way of life for us!)She could not tell me for certain but she did say she'd be surprised if they covered anything. But she did add that if his diagnosis required "life sustaining measures" -such as a feeding tube- they would certainly be there to cover that. WHAT???  I said, "You mean to tell me you will not cover any kind of therapies for autism but if autism suddenly becomes a life threatening illness you will cover THAT?" She says,"Sorry ma'am." Me too. What a load of crap!
On a positive note, I have planted a few seeds. I left our name with another ei program here-Parents As Teachers. They do 1 monthly visit. And our AEA coordinator is gathering info for us about what waivers and other services we could apply for. She also said her team could evaluate how significantly Brock was delayed and he could possibly qualify for them to pay for services he may need. That's great to know but I'm afraid we are going to be dead in the center. Brock is probably not severe enough to qualify and I bet we make too much for the income guidelines-too much to qualify for help but certainly not enough to pay for all the extras we may need. I know I'm not the only one in this perdicament-sadly there are far too many of us facing the same dilema.  Thanks for all your suggestions:)Stacy, does your DS receive EI from the state program? Our HMO was horrible with us. They gave us nothing and no one told me about EI, I found them (online)....They payed for DS's eval and they told me that the cost was 3000.00. Now, I did not get to choose where we went. They gave me 3 choices and I had to decide from only those 3 choices. Then our service coordinator made all the arrangments and when we went, they did not even ask for any insurance info, they billed EI and EI payed.
BEFORE your son turns three (like today LOL) I would call the EI service and ask that he have a full (each state calls it something different intensive, is the word here. evaluation to assess his issues or delays or whatever the Dr that saw him called the concerns. We wil do what we have to do for our children, but in our house 3 thousand is a pretty difficult chunk of change to come by............ |
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