dealing with insurance and getting into therapy

[Guest guest]

Hi everyone! I think I'm finally entering that stage

of having to deal with how to find financial

assistance to get the therapy we need. My daughter (2

in Feb) has MANY characteristics of apraxia. I've

felt that she might have it since she was 18 mos, but

of course, she was too young and it was just a wait

and see kind of thing. Our latest evaluation (at age

21 mos) at Child Watch (our Early intervention

program) said that she did have a " limited phonemic

repertoire and limited syllable structure " , but it was

low normal. Her scores now have her at the

" borderline " level for a developmental delay. She is

scheduled for an evaluation Feb 28 that the therapist

feels sure will qualify her for therapy as she will

then be developmentally delayed instead of just speech

delayed.

But, here is my problem. I'm just tired of waiting

when I KNOW that Kaeli needs help. 1 month may not

seem like a lot, but it feels like a lifetime to me

right now. Yesterday I called the Easter Seals

program and spoke to a therapist. I discussed Kaeli's

evaluation with her and she asked me some questions

about Kaeli's abilities and word attempts. She told

me that Kaeli definitely fits the profile for being

apraxic and couldn't believe articulation wasn't a

factor in the evaluation. She said that, based on

what I had told her, the articulation was SO bad that

she felt Kaeli should be in therapy now. She also

told me something we already know, that many

therapists don't know much about apraxia. She seemed

very knowledgeable about it and it was SOOOOO

refreshing to discuss this with someone that knew what

I was talking about.

Now, my insurance dilemma. Insurance will not cover

the therapy because it's not a medical condition

according to them. Delays aren't covered. Since I

will be referred to Easter Seals through EI next

month, I thought, ok, I'll just start the therapy and

pay for it myself until her next evaluation. But, I

found out that if I start the therapy at Easter Seals,

I forfeit my eligibility through EI. In other words,

I either start therapy now and pay for the duration of

the treatment (85.00 per session) or I wait 5 wks and

qualify under EI and it gets covered under Medicare.

What gives here? It just seems sad that my daughter

has to continue waiting for a magical number when she

obviously needs help learning to talk. Even the EI

therapist said that couldn't rule out apraxia, but

needed to spend more time with Kaeli first. She made

the comment that at this point her hand are tied.

So, any insurance or financial assistance experts out

there? I could sure use some help if so.

Thanks!!! Bridget

__________________________________________________

[Guest guest]

In a message dated 1/18/02 7:18:18 PM Central Standard Time,

kaelismommy@... writes:

> A

> couple of hours after talking to her there was a

> message on my machine saying that she had talked to

> her supervisor and got us squeezed into someone's

> schedule for therapy on TUESDAY!! I couldn't believe

> it!!!

>

That is great news. I started calling early start when Jenna was about 13

months old....they told me to wait through the summer.....that was such a

long wait because I knew she was behind.

Karla

SAHM to

Jackie, , Jenna and Kamryn

Visit the kids sites:

<A HREF= " http://jackierenee88.homestead.com/Jackie1.html " >Jackie</A> <A

HREF= " http://jackierenee88.homestead.com/1.html " ></A> <A

HREF= " http://jacjoejensplace.homestead.com/JennasPage.html " >Jenna</A> <A

HREF= " http://jacjoejensplace.homestead.com/NewBaby.html " >Kamryn</A>

[Guest guest]

Check out the early interventions age guidelines in your state. I live in

Indiana and we have an early intervention program called First Steps. The

state takes care of the child until they reach age 3. You pay nothing.

>From: Bridget Kirk <kaelismommy@...>

>Reply-

>

>Subject: [ ] dealing with insurance and getting into

>therapy

>Date: Fri, 18 Jan 2002 10:30:00 -0800 (PST)

>

>Hi everyone! I think I'm finally entering that stage

>of having to deal with how to find financial

>assistance to get the therapy we need. My daughter (2

>in Feb) has MANY characteristics of apraxia. I've

>felt that she might have it since she was 18 mos, but

>of course, she was too young and it was just a wait

>and see kind of thing. Our latest evaluation (at age

>21 mos) at Child Watch (our Early intervention

>program) said that she did have a " limited phonemic

>repertoire and limited syllable structure " , but it was

>low normal. Her scores now have her at the

> " borderline " level for a developmental delay. She is

>scheduled for an evaluation Feb 28 that the therapist

>feels sure will qualify her for therapy as she will

>then be developmentally delayed instead of just speech

>delayed.

>

>But, here is my problem. I'm just tired of waiting

>when I KNOW that Kaeli needs help. 1 month may not

>seem like a lot, but it feels like a lifetime to me

>right now. Yesterday I called the Easter Seals

>program and spoke to a therapist. I discussed Kaeli's

>evaluation with her and she asked me some questions

>about Kaeli's abilities and word attempts. She told

>me that Kaeli definitely fits the profile for being

>apraxic and couldn't believe articulation wasn't a

>factor in the evaluation. She said that, based on

>what I had told her, the articulation was SO bad that

>she felt Kaeli should be in therapy now. She also

>told me something we already know, that many

>therapists don't know much about apraxia. She seemed

>very knowledgeable about it and it was SOOOOO

>refreshing to discuss this with someone that knew what

>I was talking about.

>

>Now, my insurance dilemma. Insurance will not cover

>the therapy because it's not a medical condition

>according to them. Delays aren't covered. Since I

>will be referred to Easter Seals through EI next

>month, I thought, ok, I'll just start the therapy and

>pay for it myself until her next evaluation. But, I

>found out that if I start the therapy at Easter Seals,

>I forfeit my eligibility through EI. In other words,

>I either start therapy now and pay for the duration of

>the treatment (85.00 per session) or I wait 5 wks and

>qualify under EI and it gets covered under Medicare.

>What gives here? It just seems sad that my daughter

>has to continue waiting for a magical number when she

>obviously needs help learning to talk. Even the EI

>therapist said that couldn't rule out apraxia, but

>needed to spend more time with Kaeli first. She made

>the comment that at this point her hand are tied.

>

>So, any insurance or financial assistance experts out

>there? I could sure use some help if so.

>

>Thanks!!! Bridget

>

>

>

>__________________________________________________

>

[Guest guest]

Ok, you can scratch that question! I called Early

Intervention and after a few tears (I was very

frustrated) and lots of pleading, I think I got

something accomplished. Our service coordinator

actually laughed a couple of times at the absurdity of

how 2 wks can make a child eligible or ineligible. A

couple of hours after talking to her there was a

message on my machine saying that she had talked to

her supervisor and got us squeezed into someone's

schedule for therapy on TUESDAY!! I couldn't believe

it!!!

Thanks!!

Bridget

__________________________________________________

[Guest guest]

Hi Bridget,

I saw that you scratched your original message, but maybe my answer will help

someone else so here it is.

Your frustration is understandable. Your daughter is so lucky to have

a Mom who is advocating so hard for her.

Just some thoughts, get a hold of the EI rights booklet for your

state and see what the criteria is. In NJ I believe it was 33% delay

in 1 area or 25% in 2 or more. That would include fine motor, gross

motor etc. I remember when they tested my son at 27 mo. they were

concerned that he wasn't jumping off a low step or walking up and

down stairs comfortably. He also wasn't building blocks high enough

for their taste.

Also will your insurance pay for an evaluation? I would do that and

bring it back to EI. I would guess based on what you said about

forfeiting EI that it would have to be someone independent of the EI

program.

Just so you are aware from what I have read apraxia is considered a

neurological problem not a developmental delay. ANything that says

delay will typically red flag the insurance company and a denial may

occur. This is also why an evaluation from a developmental

pediatrician with knoweledge of apraxia would be helpful. I have also

read that oral apraxia is easier to diagnose at earlier ages than

verbal apraxia. Personally I don't think 2 is too young. My son did

not have his first evaluation until 26 months and did not start EI

until 27 months. My feeling never too young! It cannot hurt

especially with oral motor exercises. Check out the bookmarks for

some great posts regarding what you can do at home that is fun.

Here is a post from the archives from Dr. Marilyn AGin re: insurance

codes.

/message/5964

Hang in there and keep fighting for what your daughter is entitled to!

denise

--- In @y..., Bridget Kirk <kaelismommy@y...>

wrote:

> Hi everyone! I think I'm finally entering that stage

> of having to deal with how to find financial

> assistance to get the therapy we need. My daughter (2

> in Feb) has MANY characteristics of apraxia. I've

> felt that she might have it since she was 18 mos, but

> of course, she was too young and it was just a wait

> and see kind of thing. Our latest evaluation (at age

> 21 mos) at Child Watch (our Early intervention

> program) said that she did have a " limited phonemic

> repertoire and limited syllable structure " , but it was

> low normal. Her scores now have her at the

> " borderline " level for a developmental delay. She is

> scheduled for an evaluation Feb 28 that the therapist

> feels sure will qualify her for therapy as she will

> then be developmentally delayed instead of just speech

> delayed.

>

> But, here is my problem. I'm just tired of waiting

> when I KNOW that Kaeli needs help. 1 month may not

> seem like a lot, but it feels like a lifetime to me

> right now. Yesterday I called the Easter Seals

> program and spoke to a therapist. I discussed Kaeli's

> evaluation with her and she asked me some questions

> about Kaeli's abilities and word attempts. She told

> me that Kaeli definitely fits the profile for being

> apraxic and couldn't believe articulation wasn't a

> factor in the evaluation. She said that, based on

> what I had told her, the articulation was SO bad that

> she felt Kaeli should be in therapy now. She also

> told me something we already know, that many

> therapists don't know much about apraxia. She seemed

> very knowledgeable about it and it was SOOOOO

> refreshing to discuss this with someone that knew what

> I was talking about.

>

> Now, my insurance dilemma. Insurance will not cover

> the therapy because it's not a medical condition

> according to them. Delays aren't covered. Since I

> will be referred to Easter Seals through EI next

> month, I thought, ok, I'll just start the therapy and

> pay for it myself until her next evaluation. But, I

> found out that if I start the therapy at Easter Seals,

> I forfeit my eligibility through EI. In other words,

> I either start therapy now and pay for the duration of

> the treatment (85.00 per session) or I wait 5 wks and

> qualify under EI and it gets covered under Medicare.

> What gives here? It just seems sad that my daughter

> has to continue waiting for a magical number when she

> obviously needs help learning to talk. Even the EI

> therapist said that couldn't rule out apraxia, but

> needed to spend more time with Kaeli first. She made

> the comment that at this point her hand are tied.

>

> So, any insurance or financial assistance experts out

> there? I could sure use some help if so.

>

> Thanks!!! Bridget

>

>

>

> __________________________________________________

>