Medicaid denied Private Speech Therapy because Child's School Therapy!

[Guest guest]

Medicaid just recently denied my son's request for private speech. The

reason stated was that the service was being addressed on his IEP at school. The

problem with that is that his IEP only addresses educational

communication issues and does not address the medical, social skills or

behavioral aspect of his needs. Has anyone else experienced similar problem, and

is there a recourse; or is this decision final? He really needs this service

which is why his pediatrician ordered it. He's been making remarkable progress

and I'm afraid of him regressing. Please help!

[Guest guest]

The goals have to be different. If the goals written up by the school are the

same as the goals written up by the private therapist, it will be denied as

duplicate services. Maybe the private ST can modify the goals so they are not

the same as the IEP.

Cheryl

>

> Medicaid just recently denied my son's request for private speech. The

> reason stated was that the service was being addressed on his IEP at school.

The problem with that is that his IEP only addresses educational

> communication issues and does not address the medical, social skills or

> behavioral aspect of his needs. Has anyone else experienced similar problem,

and is there a recourse; or is this decision final? He really needs this service

which is why his pediatrician ordered it. He's been making remarkable progress

and I'm afraid of him regressing. Please help!

>

[Guest guest]

Thanks Cheryl,

When the provider and I first got the denial, they stated that it was because

his IEP had the same goals; which of course wasn't the case. The provider and I

went over his care plan and his IEP with a fine tooth comb to ensure that the

goals were very different and weren't at all similar prior to appealing. Two

weeks later we got another denial, and this time stating that " No clinical

information was received to explain why it is medically necessary for the child

to have extra speech therapy services beyond what is given at school. The

request is being denied because the clinical information did not support the

medical necessity for the requested services. " There letter stated that I could

ask for a review which would take approximately 30 days or have his doctor ask

for a 72hr emergency review. I took the route of having his pediatrician's

office submit an appeal, so now we're just waiting to hear back from them.

> >

> > Medicaid just recently denied my son's request for private speech. The

> > reason stated was that the service was being addressed on his IEP at school.

The problem with that is that his IEP only addresses educational

> > communication issues and does not address the medical, social skills or

> > behavioral aspect of his needs. Has anyone else experienced similar problem,

and is there a recourse; or is this decision final? He really needs this service

which is why his pediatrician ordered it. He's been making remarkable progress

and I'm afraid of him regressing. Please help!

> >

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