Re: insurance denies/terminates our child's speech therapy-PLEASE HELP!

February 8, 2010

Hi ...it's your buddy Tara here :)We've have the same challenges. With Logan being diagnosed at 2 and him now turning 7 in 2 weeks, we've had 5 years of basically all out of pocket expenses because of insurance denials and not receiving any assistance. We paid for most of it on credit cards (or used the cash we had and resorted to charging our groceries). Where does that leave us? We filed Chapter 13 in the Spring (the kind where you have to pay it back over 5 years because we didn't qualify for Chapter 7 thanks to being middle class). We have no more credit cards, can no longer bankroll therapy and the lovely folks that garnish my husband's wages have added another $500 per month effective this paycheck. I don't know how we are going to make it because the original payment was kicking our butt. Thankfully we are now using the scholarship and most of Logan's therapy happens at school. The only other outside thing we can afford is Kiersten's social skills class that Logan is in with Jake.

I hope that I am not sounding like doom and gloom but that is just our reality. I work odd jobs to make ends meet and spend my free time trying to lobby the State House of Reps and now Senators to PASS THE BILL! No one who cares for their child and gives them the therapy and life they deserve should be penalized like this. We're completely broke but if I had to take back one thing or change one decision about how intensely we worked on Logan's therapy, I wouldn't. Where he is at now is priceless to me.

Hugs! I won't see you on Wed because I thankfully have a night job this week.~~Tara~~

On Mon, Feb 8, 2010 at 8:22 AM, lancasterhorses <LandJPlatko@...> wrote:

I am looking for advice,tips, etc. on what to do. friday i was cornered by the receptionist and she told me that our insurance was only allowing our son a total of 6 visits left-period! he has currently been going to clinic weekly for 3 years to same speech therapist, whom he adores and has great repoire. He has global developmental delays and has autism, not to mention apraxia. I asked the reason for denial and she stated that the insurance co./medical dr. who reviewed..stated he was school-age and ready to " be released into the community " and he has school therapy. As you all know, the sparse therapy he gets at school is not enough. He is only 6 (not 65!) and he is in kindergarten. Early intervention..this is the time more than ever to help him. The going rate for this therapy is close to 300.00 an hour!!!! We do not receive any funding, scholarship,gov.assist,etc.as we fall in that middle class area.We cannot afford to pay out of pocket. I don't know who can at that rate! I will ask my speech path to submit letter and we will appeal, but there is no guarantee we will be reimbursed should we " gamble " and contine. It could take years to process appeal?speech path said her letter won't help, as they have already reviewed her " reports. " Communication is his biggest deficit and most important as we know. We have many documents from school (etr,tests,etc) reaffirming that he is functioning at very,very low levels. can anyone help give me any ideas to help appeal or convince insurance that this is a huge mistake. he has 2 medical disorders and i liken this to malpractice. would a doctor deny a kidney patient dialysis? PLEASE HELP, I am devastated to think this support life-line to him will be cut.SURE WISH WE HAD THAT AUTISM INSURANCE IN OHIO PASSED !!!feel free to email me privately if preferred.

lisa

landjplatko@...

February 8, 2010

,

Several years ago, our insurance co. informed us that they will not pay for our autistic daughter's SLP and OT therapies. after six months of appeals, we where able to reinstate OT services at thirty visits per/yr from 52, however, SLP therapy service was gone (my wife's employer's insurance benefits person and insurance co. negotiated developmental therapies for autism, etc. out of the policy).

What we did instead was find a licensed Clinical Speech Path, who worked with ASD kids at a top center, to come to our home as an individual SLP and work with our daughter 1-2 hrs per/wk, paying her out of pocket. The first therapist worked for $60 per hour, down from a hospital center based who was about $250per/hr. Later,we went on the autism scholarship and found another SLP who started at $85 per/hr. Still not cheap, but this was about the same as if we where still insured and paid for the copays and balance on what insurance did not cover, which the hospital was billing us for anyway.

In other words, SLP's do not get $300 per/hr, hospitals do. Look on the ODE's website for Autism Scholarship Providers -area individual SLP therapists, who would be willing to come to your house at a reasonable price, or if they know someone who con (no overhead in a visiting SLP other then transportation). An additional benefit, our SLP's came to some of the IEP meetings and was able to push for more speech therapy time in school, with more approperate goals and standards for our child.

You can also contact Easter Seals, who have SLP's and will work with children, fees are on a sliding scale based on family income, or so I am told.

Best of luck, I hope this helps,

-

[ ] insurance denies/terminates our child's speech therapy-PLEASE HELP!

I am looking for advice,tips, etc. on what to do. friday i was cornered by the receptionist and she told me that our insurance was only allowing our son a total of 6 visits left-period! he has currently been going to clinic weekly for 3 years to same speech therapist, whom he adores and has great repoire. He has global developmental delays and has autism, not to mention apraxia. I asked the reason for denial and she stated that the insurance co./medical dr. who reviewed..stated he was school-age and ready to "be released into the community" and he has school therapy. As you all know, the sparse therapy he gets at school is not enough. He is only 6 (not 65!) and he is in kindergarten. Early intervention..this is the time more than ever to help him. The going rate for this therapy is close to 300.00 an hour!!!! We do not receive any funding, scholarship,gov.assist,etc.as we fall in that middle class area.We cannot afford to pay out of pocket. I don't know who can at that rate! I will ask my speech path to submit letter and we will appeal, but there is no guarantee we will be reimbursed should we "gamble" and contine. It could take years to process appeal?speech path said her letter won't help, as they have already reviewed her "reports." Communication is his biggest deficit and most important as we know. We have many documents from school (etr,tests,etc) reaffirming that he is functioning at very,very low levels. can anyone help give me any ideas to help appeal or convince insurance that this is a huge mistake. he has 2 medical disorders and i liken this to malpractice. would a doctor deny a kidney patient dialysis? PLEASE HELP, I am devastated to think this support life-line to him will be cut.SURE WISH WE HAD THAT AUTISM INSURANCE IN OHIO PASSED !!!feel free to email me privately if preferred.lisalandjplatkoaol

February 8, 2010

Hi Tara,

Please check United healthcare children's foundation. Sometimes they cover what insurance doesn't cover.

Google the name.

Deepani

Re: [ ] insurance denies/terminates our child's speech therapy-PLEASE HELP!

Hi ...it's your buddy Tara here

We've have the same challenges. With Logan being diagnosed at 2 and him now turning 7 in 2 weeks, we've had 5 years of basically all out of pocket expenses because of insurance denials and not receiving any assistance. We paid for most of it on credit cards (or used the cash we had and resorted to charging our groceries). Where does that leave us? We filed Chapter 13 in the Spring (the kind where you have to pay it back over 5 years because we didn't qualify for Chapter 7 thanks to being middle class). We have no more credit cards, can no longer bankroll therapy and the lovely folks that garnish my husband's wages have added another $500 per month effective this paycheck. I don't know how we are going to make it because the original payment was kicking our butt. Thankfully we are now using the scholarship and most of Logan's therapy happens at school. The only other outside thing we can afford is Kiersten's social skills class that Logan is in with Jake.

I hope that I am not sounding like doom and gloom but that is just our reality. I work odd jobs to make ends meet and spend my free time trying to lobby the State House of Reps and now Senators to PASS THE BILL! No one who cares for their child and gives them the therapy and life they deserve should be penalized like this. We're completely broke but if I had to take back one thing or change one decision about how intensely we worked on Logan's therapy, I wouldn't. Where he is at now is priceless to me.

Hugs! I won't see you on Wed because I thankfully have a night job this week.~~Tara~~

On Mon, Feb 8, 2010 at 8:22 AM, lancasterhorses <LandJPlatkoaol> wrote:

I am looking for advice,tips, etc. on what to do. friday i was cornered by the receptionist and she told me that our insurance was only allowing our son a total of 6 visits left-period! he has currently been going to clinic weekly for 3 years to same speech therapist, whom he adores and has great repoire. He has global developmental delays and has autism, not to mention apraxia. I asked the reason for denial and she stated that the insurance co./medical dr. who reviewed..stated he was school-age and ready to "be released into the community" and he has school therapy. As you all know, the sparse therapy he gets at school is not enough. He is only 6 (not 65!) and he is in kindergarten. Early intervention..this is the time more than ever to help him. The going rate for this therapy is close to 300.00 an hour!!!! We do not receive any funding, scholarship,gov.assist,etc.as we fall in that middle class area.We cannot afford to pay out of pocket. I don't know who can at that rate! I will ask my speech path to submit letter and we will appeal, but there is no guarantee we will be reimbursed should we "gamble" and contine. It could take years to process appeal?speech path said her letter won't help, as they have already reviewed her "reports." Communication is his biggest deficit and most important as we know. We have many documents from school (etr,tests,etc) reaffirming that he is functioning at very,very low levels. can anyone help give me any ideas to help appeal or convince insurance that this is a huge mistake. he has 2 medical disorders and i liken this to malpractice. would a doctor deny a kidney patient dialysis? PLEASE HELP, I am devastated to think this support life-line to him will be cut.SURE WISH WE HAD THAT AUTISM INSURANCE IN OHIO PASSED !!!feel free to email me privately if preferred.lisalandjplatkoaol

February 8, 2010

Hi guys,I would say apply for a helping hand grant by NAA NEO to be announced soon.... In about 1 month or so. We find speech therapy among other things. I will announce these grants on this and the NAA NEO board. United healthcare is an option for grant funding and so is the national NAA helping hand program www.nationalautismassociation.org Also there are organizations like someone mentioned Easter Seals... Another like that is the Achievement Center For Children, www.achievementcenters.org. They do have sliding fee scale. But see grant money will only go so far. I think Tara is right about advocating for better insurance legislation... Also please explore

whether your county board of dd would be able to provide speech therapy. Just a thought.I know this can be a tough time but try to stay calm and be creative. Could you train a tutor to apply speech techniques to your child for a portion of the cost and use the speech therapist only say once a month? Please go to tacanow.Org for info on how to appeal insurance companies denials...many families have suceeded getting more hours who really, really fought for it!Hope this helps some. On Feb 8, 2010, at 1:49 PM, "Deepani" <DPSamar@...> wrote:

Hi Tara,

Please check United healthcare children's foundation. Sometimes they cover what insurance doesn't cover.

Google the name.

Deepani

Re: [ ] insurance denies/terminates our child's speech therapy-PLEASE HELP!

Hi ...it's your buddy Tara here

We've have the same challenges. With Logan being diagnosed at 2 and him now turning 7 in 2 weeks, we've had 5 years of basically all out of pocket expenses because of insurance denials and not receiving any assistance. We paid for most of it on credit cards (or used the cash we had and resorted to charging our groceries). Where does that leave us? We filed Chapter 13 in the Spring (the kind where you have to pay it back over 5 years because we didn't qualify for Chapter 7 thanks to being middle class). We have no more credit cards, can no longer bankroll therapy and the lovely folks that garnish my husband's wages have added another $500 per month effective this paycheck. I don't know how we are going to make it because the original payment was kicking our butt. Thankfully we are now using the scholarship and most of Logan's therapy happens at school. The only other outside thing we can afford is Kiersten's social skills class that Logan is in with Jake.

I hope that I am not sounding like doom and gloom but that is just our reality. I work odd jobs to make ends meet and spend my free time trying to lobby the State House of Reps and now Senators to PASS THE BILL! No one who cares for their child and gives them the therapy and life they deserve should be penalized like this. We're completely broke but if I had to take back one thing or change one decision about how intensely we worked on Logan's therapy, I wouldn't. Where he is at now is priceless to me.

Hugs! I won't see you on Wed because I thankfully have a night job this week.~~Tara~~

On Mon, Feb 8, 2010 at 8:22 AM, lancasterhorses <LandJPlatkoaol> wrote:

I am looking for advice,tips, etc. on what to do. friday i was cornered by the receptionist and she told me that our insurance was only allowing our son a total of 6 visits left-period! he has currently been going to clinic weekly for 3 years to same speech therapist, whom he adores and has great repoire. He has global developmental delays and has autism, not to mention apraxia. I asked the reason for denial and she stated that the insurance co./medical dr. who reviewed..stated he was school-age and ready to "be released into the community" and he has school therapy. As you all know, the sparse therapy he gets at school is not enough. He is only 6 (not 65!) and he is in kindergarten. Early intervention..this is the time more than ever to help him. The going rate for this therapy is close to 300.00 an hour!!!! We do not receive any funding, scholarship,gov.assist,etc.as we fall in that middle class area.We cannot afford to pay out of pocket. I don't know who can at that rate! I will ask my speech path to submit letter and we will appeal, but there is no guarantee we will be reimbursed should we "gamble" and contine. It could take years to process appeal?speech path said her letter won't help, as they have already reviewed her "reports." Communication is his biggest deficit and most important as we know. We have many documents from school (etr,tests,etc) reaffirming that he is functioning at very,very low levels. can anyone help give me any ideas to help appeal or convince insurance that this is a huge mistake. he has 2 medical disorders and i liken this to malpractice. would a doctor deny a kidney patient dialysis? PLEASE HELP, I am devastated to think this support life-line to him will be cut.SURE WISH WE HAD THAT AUTISM INSURANCE IN OHIO PASSED !!!feel free to email me privately if preferred.lisalandjplatkoaol

February 8, 2010

My only advice would be to contact the insurance company personally.. and

document document document.. never rely on dr's offices or hospitals to fight

harder for you... as much as they love working with your child.. they still

don't like dealing with insurance companies as much as we do.. why.. because

they may be charging you 300 a visit.. but the insurance company is most likely

only paying them 60-80 per visit.. so they lose out on money .. we had to do

this with Aetna... who refused at first to see Autism as anything but an

Educational issue.. I finally got them to approve 40 SLP sessions a year and 40

OT sessions... not exactly once a week but when you add in holidays or sick days

when we had to cancel.. it was about how many we used anyway... we also used

to sit in on his sessions and learn how they worked with him so that we could do

the same at home with him.. so on weeks we couldn't be there.. or between

visits we could continue to work with him using the same techniques that the

therapist was doing..

Also check with easter seals and MRDD who may be able to help... another option

is to check with local colleges who teach Speech and Language therapy and maybe

getting a higher school level individual to come into the home to work with your

child. They could work very inexpensively and this would also add work

experience in the field in which they are studying..

Hope that helps!!

J

Brook Park

>

> I am looking for advice,tips, etc. on what to do. friday i was cornered by the

receptionist and she told me that our insurance was only allowing our son a

total of 6 visits left-period! he has currently been going to clinic weekly for

3 years to same speech therapist, whom he adores and has great repoire. He has

global developmental delays and has autism, not to mention apraxia. I asked the

reason for denial and she stated that the insurance co./medical dr. who

reviewed..stated he was school-age and ready to " be released into the community "

and he has school therapy. As you all know, the sparse therapy he gets at school

is not enough. He is only 6 (not 65!) and he is in kindergarten. Early

intervention..this is the time more than ever to help him. The going rate for

this therapy is close to 300.00 an hour!!!! We do not receive any funding,

scholarship,gov.assist,etc.as we fall in that middle class area.We cannot afford

to pay out of pocket. I don't know who can at that rate! I will ask my speech

path to submit letter and we will appeal, but there is no guarantee we will be

reimbursed should we " gamble " and contine. It could take years to process

appeal?speech path said her letter won't help, as they have already reviewed her

" reports. " Communication is his biggest deficit and most important as we know.

We have many documents from school (etr,tests,etc) reaffirming that he is

functioning at very,very low levels. can anyone help give me any ideas to help

appeal or convince insurance that this is a huge mistake. he has 2 medical

disorders and i liken this to malpractice. would a doctor deny a kidney patient

dialysis? PLEASE HELP, I am devastated to think this support life-line to him

will be cut.SURE WISH WE HAD THAT AUTISM INSURANCE IN OHIO PASSED !!!feel free

to email me privately if preferred.

>

> lisa

> landjplatko@...

>

February 9, 2010

Oh my gosh, I just read my post and realized that I sounded like a complete Debbie Downer! I'm sorry about that. For those of you that know me personally, you know that I am about the most positive person in the world. I swear that I am The financial strain has been building and I have been bottling it up so my kids don't see it in my face and actions and kind of let out a big vent here.

Unfortunately we haven't had luck with grants and I've applied for dozens upon dozens. United Healthcare also has income limits. We have plenty of visits for speech and OT but our plan has a huge deductible and we pay a percentage of the visit after the deductible is met that varies depending on if they are in network or not.

I agree that finding a student is a GREAT idea! We have had success with that.Just be strong! You CAN do it and make it happen. Where there is a will, there is a way. Logan isn't who he is today by coincidence. He had great therapists and a crazy mommy that wouldn't take no for answer. You can do it .

~~Tara~~

February 9, 2010

Tara,

I haven't met you yet.. but I know how you feel.. this past year we had to file

chapter 7 (we don't own a home or anything yet.. )and because of that we lost

our land contract on the house we were in and had to move.... it's so

discouraging... we try to do everything that we can for our kids.. and the

bills just drown us financially and makes us feel like we are poor providers..

So.. we just do the best that we can with what we have... and go from there!

Our kids are worth it .. and that's what makes us fight to get through it every

day...

>

> Oh my gosh, I just read my post and realized that I sounded like a complete

> Debbie Downer! I'm sorry about that. For those of you that know me

> personally, you know that I am about the most positive person in the world.

> I swear that I am The financial strain has been building and I have

> been bottling it up so my kids don't see it in my face and actions and kind

> of let out a big vent here.

>

> Unfortunately we haven't had luck with grants and I've applied for dozens

> upon dozens. United Healthcare also has income limits. We have plenty of

> visits for speech and OT but our plan has a huge deductible and we pay a

> percentage of the visit after the deductible is met that varies depending on

> if they are in network or not.

>

> I agree that finding a student is a GREAT idea! We have had success with

> that.

>

> Just be strong! You CAN do it and make it happen. Where there is a will,

> there is a way. Logan isn't who he is today by coincidence. He had great

> therapists and a crazy mommy that wouldn't take no for answer. You can do

> it .

> ~~Tara~~

>

February 9, 2010

Hi ,

I am so sorry you are in this terrible situation with the insurance company. I

wish I had some advice about changing their mind but I am afraid I don't. I

would, however, like to echo 's (TM McKenna) statement about finding a SLP

in a private practice or partnership that charges a lower fee. Maybe your son

has a specialized type of speech therapy that I'm not familiar with but I think

there are fantastic SLPs out there that specialize in all levels of autism and

charge less than what you are paying now (mine is $75/session). She gives me

very specific homework to do every week, so he gets more time at home though me.

I also get material from Super Duper Publications and work independently with

him. This is definitely not a great solution (not even a good one) but if you

can't get your insurance company to relent, it is something to consider. I also

know of ABA therapists that teach language to nonverbal children and they too

are considerably less expensive than what you are currently being charged. I

wish you the best of luck,

Janice