Re: insurance YEAH!!!

[Guest guest]

I am a member of the listserve and am trying to contact

[Guest guest]

CHILDRENSAPRAXIANETGROUPS (DOT) COM

> I am a member of the listserve and am trying to contact

[Guest guest]

Hi deborah,

THe code from his slp and developmental ped. is 784.69

I do not know what code they used but did not really

care just made it a point to say, " I don't know what

code you have but on JAck's evaluation report the code

used by the developmental pediatrician and the slp is

784.69. " And I left it at that. I know she wrote it

down because she said she needed a pen.

The slp that I found is Dr. Hanrahan and she was

referred to me originally from Deborah Van de Beemt

SLP. SHe occasionaly posts here and when I said I was

moving to NH only 3 months ago she reccomended her.

She does alot of Evals, for families and she also when

she sees a child will then teach the childs therapist

how to treat them. So Although I have not met her yet

only on the phone she seems to know her stuff. She

seemed very interested in Jack and his story.

Carol another mom here has seen her with her son and

she liked her very much.

Boston children's is a fantastic hospital to go to.

Jack saw Kerry Howland there in July of " 01 " and that

is when we first heard of Apraxia (finally!) I highly

reccomend it even though it was pricey 625$ for a

whopping 1 1/2 hrs. And he did not really cooroperate

at all for her, but if I had not gone I would not have

heard of apraxia for a long time.

I hope you get this e-mail. THe group e-mail is

@... and you can also go to

Apraxia.cc and click on join our group. I hope I was

helpful. I will privately e-mail you with her phone #

Sincerely,

Eileen Derry, New hampshire

[Guest guest]

Hi Deborah,

I'm sorry if I didn't get back to you. I really try to keep up with

the phone calls and emails - sometimes I feel like Lucy in the

chocolate factory.

I see Eileen told you about Deborah L. Van den Beemt, MS CCC-SLP, who

is in the NH/VT area and sends wonderful informative posts to this

list when she can -I copied her on here and her email is

van@... (She's working on something very exciting right now!!)

And already told you the address to post to our group -

and you can search archives as

well at this site at

/ For example (now

this is funny!!) -here is an oldie but goodie post to answer an

insurance question for Eileen (yes the same Eileen who just posted

about the good news from insurance that is now helping you too!) from

Marilyn Agin MD - another professional that used to post often and

now she's crazy busy and we are all wishing there was a way to clone

her and the few professionals out there that really understand our

children! So lets all hope that Dr. Laveman doesn't book himself up

too much as well!!

From: " Marilyn Agin M.D. "

Date: Thu Nov 29, 2001 11:46 am

Subject: Re: insurance (repost)

From: Marilyn Agin M.D.

-Dear Kari, I wanted to respond to your insurance code

question for apraxia. In the ICD 9 medical code book, #315.4 is

Dyspraxia Syndrome. The confusion is that is that many of the

#315 codes are developmental, but not this one. #784.69 is

probably the safer code to use in that it comes from the section

where the codes are neurologic. I am also adding to this a

previous post (#263) which further elucidates this:

One of the forces that most of our families with apraxic children

have had to deal at some time or another is the medical

insurers. If a medical professional or speech pathologist writes a

report or a bill for submssion to the insurance company, here are

some important tenets to follow:

-Oral/verbal apraxia is a neurologic disorder so never use the

word developmental or a code that is " developmental " in the report or

on the bill.

-Useful ICD codes for Apraxia of Speech are #315.40 or #781.3.

The latter code is also one used for Hypotonia, Sensorimotor

Integraton Disorder, and Coordinaton disorder, which may be

associated with apraxia of speech.

-If there is an associated expressive language disorder with the

apraxia, which is commonly the case, use #784.6 which is " other

symbolic dysfunction. " If #315.3, 315.31, 315.39, or 315.9 are used,

these are developmental codes and may not be reimbursed.

Often the insurance co. will ask your doctor to write a Letter of

Medical Necessity of Letter of Predetermination. This needs to

state the appropriate diagnosis and code number, state that the

diagnosis(ses) have a neurologic basis and are not

developmental, and intensive treatment by qualified, experienced

speech and occupational therapists is required. Often you need to

state the specialized nature of the therapy (PROMPT, oromotor,

sensory integration, etc.) and explain why your therapist is more

qualified than the one who is " in network " for provider. Have your

therapists state their specialized credentials and certifications.

-Define apraxia as a speech disorder where the brain signals

that go to the muscles and structures of the speech mechanism are

disrupted.

-Without therapy, children do not outgrow apraxia of speech.

Speech therapy is needed at least 4x week by experienced oral motor

speech therapists. Without this therapy, prognosis for improvement

is poor.

-The provider may only provide therapy for 2 months or 6 months

of therapy. Accept it and reapply with new goals set by your speech

pathologist.

Don't be discouraged by a rejection. That's what they want, They

want to wear you down, but don't let them. This is your child and

you have to continue the fight and go to the top person in the

plan. If they tell you this is a preexisting condition, this is

absolutely absurd when talking about a child.

Be advised though, that some insurers are better than others.

Some will never offer speech services unless your child has had a

stroke or accident. (What a horrible thought). If you have a choice

of insurers, make sure you choose one wisely. Look at the

benefits before you sign up.

Good luck!

Marilyn Agin, M.D.

Medical Director CHERAB Foundation

http://www.apraxia.cc

> Hello Everyone,

> I am trying to find out about what should be covered on my

> insurance. We have a private union insurance who basically does not

> cover anything. My son has Oral Apraxia, SI and pdd-nos. He is 2

1/2...

=====

[Guest guest]

If memory serves me, UMASS-Amherst has a speech dept - perhaps they

could help you.

Marina

--- In @y..., " Steve and Deborah Haenel "

>Anyway, we are breaking away from the

> school district's free speech therapy and seeking out our own (their

> therapist just doesn't " get " that he needs specific therapy-even

>though his

> old therapist tried tirlessly to explain it and lobby for him). My

> insurance covers 21 visits (aggregate of all therapies) a year, but

not

> developmental problems. Some speech was covered before, but the

billing

> office would not tell me the diagnosis ( " in case they are wrong " )

code so I

> don't know what's worked before. Did you ever find out what that

diagosis

> code is? Was it apraxia? I know we have to be careful. We would

like to

> take him to Children's hospital in Boston for a complete evaluation-

do you

> know of anyone who has done that?

[Guest guest]

Don't quite know what this email is about, but I tried recently to enroll my

son in speech therapy at UMASS Amherst and there was a pretty long wait list

- unusual, apparently, but I would have had to wait til next semester and I

was looking in February. I ended up having him see someone at Skinner

Clinic in Holyoke. They're pretty good there. Also, there is a new yg

children's speech clinic at Cooley Dickinson Hospital. And someone quite

skilled out in Pelham MA whose name I got from UMass Amherst and am spacing

now.

I took Wiley for a full speech eval at Children's Hospital. Unlike Elaine,

apraxia was not discussed with me - I brought it up and they felt it was too

early to consider (Wiley was 26 months old) -- they also are more

conservative it seems in general at Children's when it comes to labeling

speech disorders as anything but " expressive speech disorder " or " delay. "

If your child is older, say 3 and up, and saying some things, 2 word

phrases, etc., then I think apraxia would be considered, however, at

Children's. I've really liked the people my son has seen there - they have

incredible bedside manners, etc., and are very thorough in my opinion.

Betsy

>If memory serves me, UMASS-Amherst has a speech dept - perhaps they

>could help you.

[Guest guest]

-Betsy,

I think the reason for the SLP at Boston children's to bring up

apraxia during the eval. Is because I spoke about Jack's tongue being

floppy, Could not blow bubbles Could not blow out a candle lots of

Mouth stuff. And I think it is easier to diagnose ORAL apraxia at a

younger age than other apraxia's. Jack was young at the eval 20

months but it is not unheard of to have children at 18 months being

diagnosed with Oral apraxia.

I don't know where you are in MAss But I am from there and have the

name of a couple of great people, SLP and center for an eval.I think

I have spoken to you before about this but if you want to prvt. E-

mail me at seanzonigal@... I can give you some names.

WHat are you going to do now, Do you have a diagnosis for Wiley?

Eileen

-- In @y..., " Burt " <bhollywood333@h...>

wrote:

> Don't quite know what this email is about, but I tried recently to

enroll my

> son in speech therapy at UMASS Amherst and there was a pretty long

wait list

> - unusual, apparently, but I would have had to wait til next

semester and I

> was looking in February. I ended up having him see someone at

Skinner

> Clinic in Holyoke. They're pretty good there. Also, there is a

new yg

> children's speech clinic at Cooley Dickinson Hospital. And someone

quite

> skilled out in Pelham MA whose name I got from UMass Amherst and am

spacing

> now.

> I took Wiley for a full speech eval at Children's Hospital. Unlike

Elaine,

> apraxia was not discussed with me - I brought it up and they felt

it was too

> early to consider (Wiley was 26 months old) -- they also are more

> conservative it seems in general at Children's when it comes to

labeling

> speech disorders as anything but " expressive speech disorder "

or " delay. "

> If your child is older, say 3 and up, and saying some things, 2

word

> phrases, etc., then I think apraxia would be considered, however,

at

> Children's. I've really liked the people my son has seen there -

they have

> incredible bedside manners, etc., and are very thorough in my

opinion.

> Betsy

>

>

>

> >If memory serves me, UMASS-Amherst has a speech dept - perhaps they

> >could help you.

[Guest guest]

I grew up in N'ton - I can get the name of a reportedly GREAT speech

therapist in the area if you'd like...

Marina

> Don't quite know what this email is about, but I tried recently to

enroll my

> son in speech therapy at UMASS Amherst and there was a pretty long

wait list

> - unusual, apparently, but I would have had to wait til next

semester and I

> was looking in February. I ended up having him see someone at

Skinner

> Clinic in Holyoke. They're pretty good there. Also, there is a

new yg

> children's speech clinic at Cooley Dickinson Hospital. And someone

quite

> skilled out in Pelham MA whose name I got from UMass Amherst and am

spacing

> now.

> I took Wiley for a full speech eval at Children's Hospital. Unlike

Elaine,

> apraxia was not discussed with me - I brought it up and they felt

it was too

> early to consider (Wiley was 26 months old) -- they also are more

> conservative it seems in general at Children's when it comes to

labeling

> speech disorders as anything but " expressive speech disorder "

or " delay. "

> If your child is older, say 3 and up, and saying some things, 2

word

> phrases, etc., then I think apraxia would be considered, however,

at

> Children's. I've really liked the people my son has seen there -

they have

> incredible bedside manners, etc., and are very thorough in my

opinion.

> Betsy

>

>

>

> >If memory serves me, UMASS-Amherst has a speech dept - perhaps they

> >could help you.

[Guest guest]

Hi, Marina. That would be great. Especially if he or she is so close by.

Holyoke isn't a hike but with preschool next year, etc. it could get tight.

Thank you!

Betsy

>From: " marina3029 " <philipmary@...>

>Reply-

>

>Subject: [ ] Re: insurance YEAH!!!

>Date: Mon, 20 May 2002 18:47:05 -0000

>

>I grew up in N'ton - I can get the name of a reportedly GREAT speech

>therapist in the area if you'd like...

>

>Marina