Insurance

[Guest guest]

Anyone familar with Aetna or Pacific Healthcare. Have you had any

experiences with payments for ABA or PT.OT, etc. My husband is starting

a new job in May and I wanted to get a head's up on insurance. You can

e-mail me privately.

Thanks

ohyeah99@...

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[Guest guest]

Eileen,

I feel your pain with the insurance companies. It really seems so unfair

when we are talking about precious children!!! Please continue to fight for

your child! My brother works for an insurance company and he and I have had

MANY a-go-round! But the underlying message that he always gets to me (even

though I don't want to hear it because I want someone to blame) is that

insurance companies will pay for anything as long as the employer makes it a

part of the plan that they have selected for their employees. Please,

include the employer's benefits coordinator in your fight!!

Our coverage is fairly good but our speech coverage is only a $5000 lifetime

maximum. Our speech costs $150/hr so this is less than a years worth of

total coverage. I sent a letter to the benefits coordinator of my husband's

company (a huge, global company) and told them what I thought of this

pathetic coverage. To my absolute delight, we were just notified that for

2002, the $5000 maximum has been waived! Now, I am certain that my one

letter didn't do the trick, but I believe that many other people with the

same need must have brought this to the attention of the company. Together,

things CAN get changed! Keep trying!

Mom to (36 months; developmental delays, hypotonia, apraxia) and

(17 months and a bundle of energy)

[Guest guest]

Eileen,

Where do you live? I live in Indiana and the state covers everything until

your child turns 3. At that time you can opt to put them into the special

education co-op or you can take matters into your own hands. I chose to

take matters into my hands and my daughter goes to a private pre-school, and

she sees a private SLP. My insurance pays for 100% of her ST after $100

deductible. Her diagnosis may have something to do with it also. She is

diagnosed with dev. delay and I don't think that I want to change it because

they may not cover things with a different diagnosis. Her doctor visits to

the Pediatric Neurologist, are covered I believe after a $15 copay. I would

definitely check into the state covering some expenses and seeing if

different diagnosises would cover different things. The company I work for

owns its own insurance company. It doesn't cost me anything. My husband

has to pay for his and mine covers better than his does. Hope this helps.

Sheila

[Guest guest]

Dear Sheila,

I live in Massachusetts and I have Private Insurance

through my Husband who is in a union. They are not the

best insurance, but are great if you are a drug

addict, they cover everything oh yeah also if you go

to a Chiropractor LOL!!!! Jack also needs a

Neuromuscular Stimulator for his Brachial Plexus

injury from Birth and they will not cover that either.

That cost 150$ a month on top of the 340$ a month for

the ST. I have letters stating that Apraxia is a

neurolgical disorder and they do not care. The only

way they would pay is if Jack had a stroke!! go

figure. I obvioulsy do not have a choice to keep this

therapy going I just wish that these insurance co.

would give the money back to the families instead of

in their pockets!!

Jack is receiving Early intervention until May 2002

but they do not have training in Apraxia and that is

what he needs. He is still receiving ST through Early

intervention 1hr a week but just continuing what the

private ST does. The private ST has just completed the

course in PROMPT.

Anyway, thank you for your info. I appreciate it.

Sincerely,

Eileen

--- " S. Surfus " <sillybear65@...> wrote:

> Eileen,

> Where do you live? I live in Indiana and the state

> covers everything until

> your child turns 3. At that time you can opt to put

> them into the special

> education co-op or you can take matters into your

> own hands. I chose to

> take matters into my hands and my daughter goes to a

> private pre-school, and

> she sees a private SLP. My insurance pays for 100%

> of her ST after $100

> deductible. Her diagnosis may have something to do

> with it also. She is

> diagnosed with dev. delay and I don't think that I

> want to change it because

> they may not cover things with a different

> diagnosis. Her doctor visits to

> the Pediatric Neurologist, are covered I believe

> after a $15 copay. I would

> definitely check into the state covering some

> expenses and seeing if

> different diagnosises would cover different things.

> The company I work for

> owns its own insurance company. It doesn't cost me

> anything. My husband

> has to pay for his and mine covers better than his

> does. Hope this helps.

> Sheila

>

>

>

__________________________________________________

[Guest guest]

Dear ,

Thank you so much for your encouraging words. I think

we as parents of such wonderful children need to hear

or read these " You go girl " words to literally keep us

going. There are days when I just can't be on the

phone with the insurance co. trying to convince them

that Apraxia is a neurological disorder and that my

husband pays $4.50 an hr just to have benefits. He is

in the union and their insurance is private so I do

not know but need to find out how to fight Prvt.

insurance companies. I just wanted to thank you for

the great info and for picking me up when I am

obvioulsy irritated and sad.

Sincerely,

Eileen

> Eileen,

> I feel your pain with the insurance companies. It

> really seems so unfair

> when we are talking about precious children!!!

> Please continue to fight for

> your child! My brother works for an insurance

> company and he and I have had

> MANY a-go-round! But the underlying message that he

> always gets to me (even

> though I don't want to hear it because I want

> someone to blame) is that

> insurance companies will pay for anything as long as

> the employer makes it a

> part of the plan that they have selected for their

> employees. Please,

> include the employer's benefits coordinator in your

> fight!!

>

> Our coverage is fairly good but our speech coverage

> is only a $5000 lifetime

> maximum. Our speech costs $150/hr so this is less

> than a years worth of

> total coverage. I sent a letter to the benefits

> coordinator of my husband's

> company (a huge, global company) and told them what

> I thought of this

> pathetic coverage. To my absolute delight, we were

> just notified that for

> 2002, the $5000 maximum has been waived! Now, I am

> certain that my one

> letter didn't do the trick, but I believe that many

> other people with the

> same need must have brought this to the attention of

> the company. Together,

> things CAN get changed! Keep trying!

>

>

> Mom to (36 months; developmental delays,

> hypotonia, apraxia) and

> (17 months and a bundle of energy)

[Guest guest]

Eileen,

I am sorry to hear about your insurance company!! It is terrible what these

insurance companies are getting away with. Have you tried to see if a

different diagnosis would get some of the therapies covered. My insurance

company will cover ST but only 80% of the OT even though it is the same

diagnosis, does that make any sense? I wish I knew what to tell you to do,

but I don't, and I am deeply sorry about that.

Sorry,

Sheila

>

>Dear Sheila,

>I live in Massachusetts and I have Private Insurance

>through my Husband who is in a union. They are not the

>best insurance, but are great if you are a drug

>addict, they cover everything oh yeah also if you go

>to a Chiropractor LOL!!!! Jack also needs a

>Neuromuscular Stimulator for his Brachial Plexus

>injury from Birth and they will not cover that either.

>That cost 150$ a month on top of the 340$ a month for

>the ST. I have letters stating that Apraxia is a

>neurolgical disorder and they do not care. The only

>way they would pay is if Jack had a stroke!! go

>figure. I obvioulsy do not have a choice to keep this

>therapy going I just wish that these insurance co.

>would give the money back to the families instead of

>in their pockets!!

[Guest guest]

Hi, my name is Kathy, my son has dyspraxia, and was just properly diagn. a

15 months ago. I fought the insurance co. by appealing, I exhausted my

appeals through them, and then went through the State. The state ruled in my

Son's behalf, if you can call it that. I now get 30 sessions a year, which

is better then " 0 " . First go through the insurance co. and submit

everything you have including a letter of medical necs. from your ped. or

primary care doctor, and document everthing, and then go through the state.

Good luck.

[Guest guest]

Wow Eileen!

What great news, Congratulations!! How many appeals did you go

through before they accepted? Did you ever speak to them or was it

all through the mail? Who wrote the letters you sent? And could you

send an example of one here (and leave blanks for doctors names-

personal info, etc.) so all of us could have an idea of what you said?

I know that Dr. Agin always gives the same advice as you when it

comes to insurance companies - don't give up -that's what they are

counting on! It will be great when we don't have to become such

advocates just to help our children get the help they need-doesn't

seem fair! That's why it's so great to read messages like yours.

Thanks! (and go for the private too!)

=====

[Guest guest]

Hi, I saw your message posted on the apraxia site. I have a ten year old

son who was just correctly diag. with dyspraxia, after years of little

improvement is now seeing the benefits of the correct treatment. I filled

3 appeals with my insurance co. then when this didn't work I contacted the

State of New Jersey Health and Senior Services Department. I documented

everything from Neur. report, Primary Care Doctor's (Letter of Medical Nec.)

to all the speech reports and filled an appeal through the State. It cost me

$25.00 to get the process rolling. They ruled in my son's case. You have

to take apart the benefits listed in your insuracne policy. The best I

could get was 30x a year. I pay for the rest and I homeschool him because

the district was not going to give him the phonics program or reading

program he needed in kindergarten etc. He does receive speech 3x a week

through the district. It is not the best but it is getting better. Keep

fighting, Good luck, Kathy Bence

[Guest guest]

Dear , I have been wanting to e-mail you and thank you for all your good

work. I found the Apraxia site when I was trying to search for information

on speech disorders and why my son was not improving with trad.

speech therap. It was the information that I found on your site that lead me

in the right directions, after years of frustration.

I fought my Insurance Co. I documented everything (Letter of Medical Necs.)

from primary care Doctor. Neur. Report, Speech Report. Etc. After appealing

3x to my insurance co. I contacted the State of New Jersey Department of

Health and Senior Services. I received a form to file an appeal through the

State, it cost me $25.00 to get the process started, and they ruled that I

had a case.

[Guest guest]

Dear Buffy,

I do not know where you are but I know that you can

get a different insurance in some states, I live in

MAssachusetts and here there is a insurance called,

Common Health you pay a certain deductable a month

depending on how much you make a year and it would

cover just your son, you pay no copay or anything. I

actually learned about it from our social worker that

we saw at one of JAck's evaluations. When I spoke to

my insurance company and mentioned it to them they had

no Idea what I was talking about, figures. I hope this

helps.

Eileen

> Hi, I am very frustrated with our insurance company.

> We had our son evaluated at a speech clinic. This

> is the 4th appeal and we have been denied again. He

> has severe apraxia. I don't understand because the

> director of this clinic said there are kids going

> there with less severe cases and they are being

> covered fully. We are writing to the insurance

> commissioner and also to the president of the

> company my husband works for. My child needs this

> therapy desperately. He does get speech thru our

> local preschool 4days a week with 1 session in the

> classroom. What resources are there??? I have

> checked with easter seals, social security, etc. I

> will keep fighting for my child. Any input would be

> appreciated. Buffy

[Guest guest]

I have a question about insurance. I was reading something about

insurance...tha family act of 2001(something like that). Supposedly it will

let those with a special child get medicaid if without treatment would be an

issue as an adult...the information didn't say too much, but I am interested

in knowing more. I need help, but we " make too much money " ...Thanks

>

>Dear Buffy,

>I do not know where you are but I know that you can

>get a different insurance in some states, I live in

>MAssachusetts and here there is a insurance called,

>Common Health you pay a certain deductable a month

>depending on how much you make a year and it would

>cover just your son, you pay no copay or anything. I

>actually learned about it from our social worker that

>we saw at one of JAck's evaluations. When I spoke to

>my insurance company and mentioned it to them they had

>no Idea what I was talking about, figures. I hope this

>helps.

>Eileen

[Guest guest]

Hi Group

Read this- it is important Here's the deal- we were having problems

with out insurance too. They basically excluded my son from any

coverage that had to do with developmental delays, neurological

problems, autistic disease of childhood etc etc. I contacted the

Dept of Human Resources in the county where I live and applied for

something called the Deeming Waiver. In some areas it is known as

the Beckett Waiver. It is a special type of Medicaid that

children with special needs can get if their parents income is over

the limit for other types of government aid. I am a sahm and my

husband owns his own business. We were above the income brackett to

get any type of aid. We applied for this waiver in our son's name

and after about 4 weeks it came through. They told us it usually

takes up to 3 months but it will cover any medical expenses that you

have incurred since the date you apply.

Since our insurance was denying coverage for OT services,

developmental pediatrician and everything else, this Medicaid now

opens the door to many many professionals that my son would not have

ad the opportunity to see otherwise. Our insurance denied us

access to a developmental pediatrician at Emory University. Now,

with the Medicaid, we can go. Hallelujah!!.

If anyone is interested in this I will be glad to let you know more.

We live in GA but every state has Medicaid so you just have to know

what to ask for. The only way we knew was by way of the EI people.

Stacey

staceydaniel@m...

" I have a question about insurance. I was reading something about

insurance...tha family act of 2001(something like that). Supposedly

it will let those with a special child get medicaid if without

treatment would be an issue as an adult...the information didn't say

too much, but I am interested in knowing more. I need help, but

we " make too much money " ...Thanks

[Guest guest]

-Dear ,

I did not go through appeals exactly, I spoke to them many times on

the phone and sent them evaluations, from everyone that I had seen

who gave finally a diagnosis of Apraxia, I sent them important

information (articles) on Apraxia so they could see what it is and

the seriousness of it all. I did not write a fabulous letter since I

am not a great letter writer. I kept the letter short sticking to the

facts I did not get emotional which was extremely hard to do. I let

the information on apraxia and the evaluations that we had done with;

Developmental Psychologist, Developmental Pediatrician, and 2 SLP's

speak for themselves. It was all I needed to do but the process takes

a long time 5 months to be exact.

My insurance is private so they do things differently than HMO's. It

is a huge win for us since we also are fighting them for another

issue that JAck has. He was born with a Brachial Plexus injury that

completly paralized his right arm for about 3 months after birth.

Needless to say he needs a Neuromuscular Stimulation unit to get his

Scapular muscles working the unit cost 150.00 $ to rent a month and

my insurance refuses to pay, So I am still fighting them but am

hopeful that they will come around.

Anyway that is about it and I am starting to get them to pay for

private therapy. Boy just dealing with the insurance company is part

time job in itself.

Sincerely,

Eileen mom to JAck 2 1/2 and 1 yr.

-- In @y..., "

[Guest guest]

Dear Dorothy,

I thought I sent this off yesterday, but it was in my drafts box. I think my

computer dislikes me. LOL I don't think anyone could argue with you, you do

your homework. If you have enough people to ask for the links, I would like to

read them, but I don't want you to use up your valuable time for just 1 person.

You have a true moral identity in how you describe things in ethical terms. I

don't think is a contest, because in the end, what we think will go unnoticed by

the " great majority " .

I had to seek medical care in England, France and Italy and I found something

lacking. In England, and I hope no one takes offense, but I am being candid

about my own experience and that of a friend. The doctors and nurses were on

strike in England. I think they were perhaps seeking higher wages, I have now

forgotten what their gripe was about. I had to seek a doctor in the private

sector. She was of absolutely no help. She never touched me, listened to my

heart or took my blood pressure which is usually SOP here. She asked what my

doctor here did and I said he gave me a steroid injection in the affected joint

and a prescription. She informed me that they didn't give injections and gave

me a script for the chemist for 4 pills until I could get home and see my own

doctor. Jimmy had better luck with the doctor at Heathrow. I think it is

possible that they treat tourists differently. In France, I know they do make

house calls, one came to our hotel, but the one who was summoned was a

chiropractor who proposed taking an aspirin for vertigo. My arthritis flared up

in my knee and I was given a stretch bandage to wear in Italy.

One of the ladies in our group became ill on the bus in Germany, and an officer

happened to look in the bus where she was sitting alone and found her to be very

ill, so he ordered an ambulance. They said because she was not a citizen, she

could only stay in the hosital for 5 days. One in the group who was a close

friend, stayed with her and we continued on our trip. Her son had to medivac

her to the US after 5 days. Another friend who was born in Holland went home

for the Christmas holidays when she became ill. They put her in a private room

with the best care. As soon as they were able to read what Medicare would

reimburse, they put her in a ward with 6 men. I have never heard of any

hospital putting a woman in with 6 men. How's that for privacy or former

citizen.

So I have personally found experiences in different countries and did not find

they compared with my own in this country. I was only reimbursed a small

portion I paid by Blue Cross. I am not an expert in negotiations and don't

understand all the legalise, but I do not want to see the day when we have some

one tell us we are too old to have medical care or surgery for a broken hip, or

wait 2 years to have it. Doctors are fed up with the government squeezing them.

One of my doctors told me if all his patients were on Medicare or Medicaid, he

would have to close his doors.

There is a Doctor from Kentwood, LA, Dr. Randolph Howes who wrote a letter to

the editor today, and says thusly: " Heavy storm clouds are gathering concerning

the health care of our nation. " He goes on to say that our medical care is

somewhere in the middle as compared to industrialized nations and that we pay

double the amount per capita as do other nations. In a survey, 82% of doctors

felt revenue from their practice was either flat or decreasing. Many complained

that their practice has become less satisfying in the past decade. Only 2% of

our medical graduates intend to go into primary care or emergency medicine.

There will be huge potholes in the medical arena, as many doctors are reaching

the age of retirement. In his own words, he says the governemnt wants to run

our health care, but cannot run a " snow ball stand " efficiently or have it be

cost effective. Medicare and Medicaid is now on life support.

What scares me is what road are we going down on? Where will we find doctors to

cover the needs of the nation as a whole. Can you go anywhere without seeing

foreign names and deep accents? I think this means we have a shortage of our

young men who are entering medical school. Are we going to have to import all

of our physicians because they are willing to accept less, but still make more

than in their country? In Third world countries doctors are paid a pittance,

not much more than one who collects garbage, so they are glad to come here.

They are supposed to be here temporarily and then go back to their country.

There is a loop hole in the law that if they have a specialty and there is a

town without a specialist, then he can fill in that space, but they never leave

and they don't stay in that post. They make the circuit. The doctor who

diagnosed me was so rude and insulting I reported him and he was fired. He left

for a while, and then came to the next town. He was not liked there either, so

he went to a bigger city., where I lost track of him.

When I was in the hospital with c-difficile, there were two foreign doctors from

the middle east. One was nice and walked in with a smile and nice greeting. The

other had absolutely no bedside manner. I asked about the c-difficle and he

said I didn't have it. I said the nurse just left and she said I had it and he

arguably said, I did not have it. I told Jimmy to run after him and get him to

write it down. He grabbed a pad from the desk and wrote - colustridium

dlficille. In essence he called both me and the nurse liars. When he

re-checked the charts he found that we were both right. No apologies from him.

Jimmy and I were going to the parking garage of the hospital when he was

exiting. He gave us a half smile and Jimmy turned and looked at me and said,

" Isn't that the doctor who was so rude to your? " I said it was. I told my

primary doctor that I did not want him coming to see me, to put it in my chart.

You see it everywhere in other cities as well.

Whether this new plan is a means to an end, only time will tell. I have seen in

the news that people in Canada come here for surgery because of the long waiting

list. There will be different discourses and I always appreciate and laud your

opinions as you are always well informed. In the end, we will have to

individually take everything into consideration before coming to ourr own

conclusions. Most people in congress do not openly seek our opinions, but we

can certainly use the power of our voice through mail, faxes and emails. Thank

you Dorothy for your discourse. I know with your experience, you can make a

difference for a lot of people.

Hands and hearts,

Lottie

[Guest guest]

Lottie--usually there is a file called " drafts " or something like that--did you

look there? I hate when that happens!

Vicki

>

> I spent 2 hours looking up insurance for several countries on how they

operated and collected funds to create national healthcare. I left it in my

inbox overnight thinking I was going to finish and send it today. My computer

was closed down to bring my programs up to date and I lost it. I tried to

restore my last session, but it was nowhere to be found. I looked at my files

and it was nowhere to be found there, either. Any idea of how I can recover

that information. There was no name on the address line, so it didn't go to

anyone, but I would like to retrieve all that information. Is it possible?

>

> Thanx,

> Lottie Duthu

>

>