Insurance not covering speech therapy??
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My little sister who is 4 (5 in January) has a speech delay and my dad and step mom had her in private speech therapy till they pulled her out because of the insurance company saying it was not covered. Her diagnosis is Appraxia (sp?) and possible OCD. She also holds her tongue wrong or something like that whic is something my little brother struggles with as well. Her speech is at the level of a 15 month olds and you cannot understand a single word she says! A sentence from her sounds like this= Tell Nickie (my lil bro) to say sorry' is this "Ta Neeke ta tay taway' Thats actually a clear sentence right there. She used the "T" sound for pretty much everything and throw a few diff ones in there and most words dont even sound remotely close to the right one. Thats all i can think of right now but often what she says is sooo completely off from what she is trying to say (meaning the sounds are completely the wrong ones etc. but anyway its pretty bad and most of the time we have no clue what shes saying or wants and my lil brother is her interpretor but at times he doesnt even know what shes saying and it started getting to the point where she stopped trying to communicate at all and kinda of depressed and withdrawn. Since speech therapy she talks so much and is getting much clearer tho we still cant understand her most of the time. She is still getting speech therapy 3x a week thru the school district tho. THe insurance comp. said that unless they can prove that she had appraxia before 1 year of age it wasnt covered, i mean thats completely ridiculous esp since kids arent even speaking by that age! They also stated that they disagree with that diagnosis. Could it be she really doesnt have appraxia but was misdiagnosed? Either way i think its screwed up that they are not paying. ETA: Also she was DX'ed with Apraxia by a speech pathologist. A nuerologist said he didnt think it was apraxia (which would be nuerological?) but she did have a significant speech delay with OCD tendencies but too young to DX (the OCD). Maybe because of conflicting reports? services. It was constantly an uphill battle. In our case, they didn't want to pay because, according to them, why should they pay for services if the school system would provide them for free. We persisted and after an evaluation by the school system, an IEP, and a referral, they finally agreed to pay. We still had to fight them at least once every few months. I wish the insurance companies would focus on actually insuring people instead of trying to pay as few claims as possible. Okay--I was told this because of my fear that my husband's insurance would not cover therapies. Now, this is heresay but, have been told this in two states: The public school system must cover speech therapies, as well as other therapies. If a child has a disability, even if SSI is denied, I was TOLD medicaid would always be there, no matter what the financial situation, as long as the child is listed as an SSA disability. Back home, we didn't have many that home schooled and public schools had to do preschool at age 3 for all kids with challenges that were in EI and had an IEP written when they entered, with official dx. If they don't go to said preschool, the school system would still cover the therapies--which is a pain cuz, you have to go back and forth JUST for therapies if there is no preschool program. Now, I was told that by professionals in two states--the last one that told me that was my case manager who also has parents that have adopted 4 kids on the spectrum. I would hope it to be true and maybe something you can check in with an EI agency--since they do follow up after EI ends to make sure child is placed. I wouldn't take anyone's word (especially mine, since it is all told to me and not experienced for sure) for it unless you are told by someone in your area, as well as advocates that deal with this issue. That's just MHO, but I hate to see any child denied anything. Insurance companies get rich and give little back. Children need these therapies and should not be denied them. Please check with your local societies in your area on this. God Bless, Kelly [QUOTE=Kelly4Jesus]If they don't go to said preschool, the school
[/QUOTE] We were actually allowed to keep my son in private preschool last school year and the school system sent a private speech therapist to his preschool for onsite therapy. That was all through the EI program. This is Louisiana though, and at the time, they said B didn't meet the requirements to be in the ECSE. Btw, we have since moved and are in a different parish now. The school system, and special ed department, is much better here. All of a sudden, we are getting so much therapy from the school system and he is making great progress. Sorry for veering slightly off topic for a moment. [QUOTE=mickeymom] [QUOTE=Kelly4Jesus] If they don't go to said preschool, the school
In Mass., the private schools were Catholic. There, they wouldn't accept a child with an IEP. If you homeschooled (not a popular thing in Mass, like it is in Kansas), then you had to take your child to the therapies if you didn't attend their school. I am not Catholic so, it wasnt a big deal for me--but therapies was something I kenw were important so, I made sure they got into the preschool program. Taylor was in the fully ASD one that went most of the day and Colin in the nt/challenged 2 hour program. Anyway, I hope it is true, what I was told--that medicaid will always be there for our kids--I just am not sure--havent had to deal with that--yet. Resources for fighting insurance: http://www.autism-pdd.net/forum/forum_posts.asp?TID=18097&am p;KW=insurance
In our current SD, our preschool underdiagnoses kids, and then the elementary school is stuck doing MORE therapies. But, when T aged out of EI, the school district I then lived in said they would provide therapy, but at a remote elementary school off the bus lines (I do not have a car). What BS. Knowing her EI therapist would provide far more efficient and effective therapy, I signed her up for 6 months of weekly stuff and a local benevolent organization paid about half of the fees -- the SLH dept at the hospital had a "program," through them. I paid a chunk out of pocket, but frankly it was worth every penny! Plus I got to observe and could apply to a limited extent at home what I learned! Typically, the party line for insurance companies is that they will only cover speech therapy if it is "restorative in nature." What this means is that if you have a stroke and lose speech, therpay is covered. For a child that never spoke, it isn't. Some kids have "delays." A delay is something that will get better on it's own, over time, with no intervention. Though obviously kids with delays catch up quicker if they have therapy. Some kids have "disorders." A disorder is something that will not automagically get better over time, and requires treatment. Note, word choice is important when talking to insurance. Your child has a MEDICAL CONDITION that requires TREATMENT. Not a DEVELOPMENTAL DELAY that requires THERAPY. You may need to have your physician write a letter of medical determination. I've heard of insurance companies denying on alot of stuff before, but to be honest, apraxia is usually a slam dunk. When my son was 2 the speech therapist said that they weren't sure what C had, so they coded the invoices for apraxia (because insurance pays on apraxia and it was one of the options for C at the time). Turns out he didn't have apraxia, but the invoices were coded that way (and stayed that way) and my insurance companies (1st Cigna for 3 years, then Aenta for 2 years) paid on private speech and OT for 5 years for us. Fight it. Thanks everyone! Norwaymom, I will forward the links to my step-mom, thankyou. Kristys, Thanks so much for the explanations, that makes sense. I cant believe they are denying for apraxia and they want proof that she had apraxia before age 1 is ridiculous, i think! Thanks again There could have been signs of swallowing apraxia prior to age 1, but I don't know if there necessarily has to be feeding issues in a child with verbal apraxia. Good luck to your step-mom. |
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