Guest guest Posted October 7, 2006 Report Share Posted October 7, 2006 United's official policy is 20 visits of speech therapy per year if your child had an " injury, stroke, or congenital anomaly " . When I called the person parroted the exact terms above PLUS the term " Autism " . This to me means their book is different from mine and fighting it is worthwhile even when the outcome may be not what was hoped for. I have learned through experience that the policy's terms are flexible if you know how to work the system. > > > > This pediatrician may simply be aware that this certain HMO NEVER covers pediatric ST and OT. Not that it is not worth asking the question, but don't shoot the messenger. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 7, 2006 Report Share Posted October 7, 2006 " I have learned through experience that the policy's terms are flexible if you know how to work the system. " I completely agree. Somehow my son's private SLP managed to get 60 visits out of united. I don't know how she did it; she's something of a miracle worker. He does not have an official diagnosis yet, but she did research codes online (and I know she has the Late Talker book). She also tries to form a contact at the insurance company when she works on a claim and follows up with that same person each time. > > > > > > This pediatrician may simply be aware that this certain HMO > NEVER covers pediatric ST and OT. Not that it is not worth asking > the question, but don't shoot the messenger. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 7, 2006 Report Share Posted October 7, 2006 " I have learned through experience that the policy's terms are flexible if you know how to work the system. " I completely agree. Somehow my son's private SLP managed to get 60 visits out of united. I don't know how she did it; she's something of a miracle worker. He does not have an official diagnosis yet, but she did research codes online (and I know she has the Late Talker book). She also tries to form a contact at the insurance company when she works on a claim and follows up with that same person each time. > > > > > > This pediatrician may simply be aware that this certain HMO > NEVER covers pediatric ST and OT. Not that it is not worth asking > the question, but don't shoot the messenger. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2006 Report Share Posted October 9, 2006 would you please find out how your SLP managed to get speech covered from United. That is wonderful! My SLP keeps saying that the codes I am asking her to try are unethical because they are OT codes. myjunkytrash <myjunkytrash@...> wrote: " I have learned through experience that the policy's terms are flexible if you know how to work the system. " I completely agree. Somehow my son's private SLP managed to get 60 visits out of united. I don't know how she did it; she's something of a miracle worker. He does not have an official diagnosis yet, but she did research codes online (and I know she has the Late Talker book). She also tries to form a contact at the insurance company when she works on a claim and follows up with that same person each time. > > > > > > This pediatrician may simply be aware that this certain HMO > NEVER covers pediatric ST and OT. Not that it is not worth asking > the question, but don't shoot the messenger. > --------------------------------- Get your own web address for just $1.99/1st yr. We'll help. Small Business. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2006 Report Share Posted October 9, 2006 would you please find out how your SLP managed to get speech covered from United. That is wonderful! My SLP keeps saying that the codes I am asking her to try are unethical because they are OT codes. myjunkytrash <myjunkytrash@...> wrote: " I have learned through experience that the policy's terms are flexible if you know how to work the system. " I completely agree. Somehow my son's private SLP managed to get 60 visits out of united. I don't know how she did it; she's something of a miracle worker. He does not have an official diagnosis yet, but she did research codes online (and I know she has the Late Talker book). She also tries to form a contact at the insurance company when she works on a claim and follows up with that same person each time. > > > > > > This pediatrician may simply be aware that this certain HMO > NEVER covers pediatric ST and OT. Not that it is not worth asking > the question, but don't shoot the messenger. > --------------------------------- Get your own web address for just $1.99/1st yr. We'll help. Small Business. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2006 Report Share Posted October 9, 2006 I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child... " I have learned through experience that the policy's terms are > flexible if you know how to work the system. " > > I completely agree. Somehow my son's private SLP managed to get 60 > visits out of united. I don't know how she did it; she's something > of a miracle worker. He does not have an official diagnosis yet, > but she did research codes online (and I know she has the Late > Talker book). She also tries to form a contact at the insurance > company when she works on a claim and follows up with that same > person each time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2006 Report Share Posted October 9, 2006 I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child... > > > > > > > > This pediatrician may simply be aware that this certain HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > > the question, but don't shoot the messenger. > > > > > > > > > --------------------------------- > Get your own web address for just $1.99/1st yr. We'll help. Small Business. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2006 Report Share Posted October 10, 2006 I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child... " I have learned through experience that the policy's terms are > flexible if you know how to work the system. " > > I completely agree. Somehow my son's private SLP managed to get 60 > visits out of united. I don't know how she did it; she's something > of a miracle worker. He does not have an official diagnosis yet, > but she did research codes online (and I know she has the Late > Talker book). She also tries to form a contact at the insurance > company when she works on a claim and follows up with that same > person each time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2006 Report Share Posted October 10, 2006 I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child... > > > > > > > > This pediatrician may simply be aware that this certain HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > > the question, but don't shoot the messenger. > > > > > > > > > --------------------------------- > Get your own web address for just $1.99/1st yr. We'll help. Small Business. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2006 Report Share Posted October 11, 2006 Is there a separate code for " dyspraxia " ? The doctor stated that my son was dyspraxic, but then neglected to use the code for it. alpy2@... wrote: The doctor is wrong about apraxic kids not being able to speak necessarily. The doctor is assuming that apraxia means total lack of speech (from Latin root " a " which means " absence of " ). Technically, he's correct. Technically, a child who can speak but not properly would be " dyspraxic. " But in the U.S., these terms are interchangeable (in Britain I believe they tend to make this distinction that we Americans usually don't). Perhaps your doctor would be more comfortable with a diagnosis of " dyspraxia. " Hope this helps! Sandy, Illinois (alpy2@...) Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA reauthorization) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2006 Report Share Posted October 11, 2006 Is there a separate code for " dyspraxia " ? The doctor stated that my son was dyspraxic, but then neglected to use the code for it. alpy2@... wrote: The doctor is wrong about apraxic kids not being able to speak necessarily. The doctor is assuming that apraxia means total lack of speech (from Latin root " a " which means " absence of " ). Technically, he's correct. Technically, a child who can speak but not properly would be " dyspraxic. " But in the U.S., these terms are interchangeable (in Britain I believe they tend to make this distinction that we Americans usually don't). Perhaps your doctor would be more comfortable with a diagnosis of " dyspraxia. " Hope this helps! Sandy, Illinois (alpy2@...) Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA reauthorization) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 I know that the PT and the OT use the same code of Low muscle tone, and my daughter's SLP uses many methods during the session that I would consider OT. A good bit of time during her speech session is spent performing exercises to strengthen her mouth. She is a great SLP but she just feels that using what she considers to be an OT code is not something she will do. She just reminds me to be careful of what I am reading from this group. Also, I don't think there are codes designated just for speech, or OT, I assumed the codes were to describe a diagnosis. She uses the code for verbal apraxia and the OT uses the code for muscle tone, the OT could very well use the apraxia code because they go hand in hand. myjunkytrash <myjunkytrash@...> wrote: I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child... > > > > > > > > This pediatrician may simply be aware that this certain HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > > the question, but don't shoot the messenger. > > > > > > > > > --------------------------------- > Get your own web address for just $1.99/1st yr. We'll help. Small Business. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 Greetings... I'm an SLP and I try to keep up with this posting because a lot of good ideas are shared here. This posting on insurance issues intrigued me and I thought I would reply... Basically, anyone can use those billing codes, but typically, insurance companies have a list of acceptable billers (e.g., anyone can bill using the low muscle tone code, but only PT and OT may get reimbursed). Also, insurance companies tend to track codes and the people who are billing them. If they find an SLP is using an " atypical " code, they may request an audit (which, yes, is similar to an IRS audit). So, this is tricky business. Personally, I tend to look up those codes I am considering (either through the insurance companies website or on my professional website) before billing if it is an " atypical " code. Most professions have a list of codes that are accepted for that profession. Hope this helps!! J. @...: jaemegcola@...: Thu, 12 Oct 2006 06:48:54 -0700Subject: Re: [ ] Re: insurance issues I know that the PT and the OT use the same code of Low muscle tone, and my daughter's SLP uses many methods during the session that I would consider OT. A good bit of time during her speech session is spent performing exercises to strengthen her mouth. She is a great SLP but she just feels that using what she considers to be an OT code is not something she will do. She just reminds me to be careful of what I am reading from this group. Also, I don't think there are codes designated just for speech, or OT, I assumed the codes were to describe a diagnosis. She uses the code for verbal apraxia and the OT uses the code for muscle tone, the OT could very well use the apraxia code because they go hand in hand. myjunkytrash <myjunkytrash@...> wrote: I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child...> > > > > > > > This pediatrician may simply be aware that this certain HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > > the question, but don't shoot the messenger. > >> > > > > > > ---------------------------------> Get your own web address for just $1.99/1st yr. We'll help. Small Business.> > [Non-text portions of this message have been removed]>__________________________________________________Do You ?Tired of spam? has the best spam protection around http://mail. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 The code for Apraxia is 784.69 Gordon <momster451@...> Sent by: cc: @yaho Subject: Re: [ ] Insurance issues ogroups.com 10/11/2006 10:09 AM Please respond to Is there a separate code for " dyspraxia " ? The doctor stated that my son was dyspraxic, but then neglected to use the code for it. alpy2@... wrote: The doctor is wrong about apraxic kids not being able to speak necessarily. The doctor is assuming that apraxia means total lack of speech (from Latin root " a " which means " absence of " ). Technically, he's correct. Technically, a child who can speak but not properly would be " dyspraxic. " But in the U.S., these terms are interchangeable (in Britain I believe they tend to make this distinction that we Americans usually don't). Perhaps your doctor would be more comfortable with a diagnosis of " dyspraxia. " Hope this helps! Sandy, Illinois (alpy2@...) Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA reauthorization) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 I know that the PT and the OT use the same code of Low muscle tone, and my daughter's SLP uses many methods during the session that I would consider OT. A good bit of time during her speech session is spent performing exercises to strengthen her mouth. She is a great SLP but she just feels that using what she considers to be an OT code is not something she will do. She just reminds me to be careful of what I am reading from this group. Also, I don't think there are codes designated just for speech, or OT, I assumed the codes were to describe a diagnosis. She uses the code for verbal apraxia and the OT uses the code for muscle tone, the OT could very well use the apraxia code because they go hand in hand. myjunkytrash <myjunkytrash@...> wrote: I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child... > > > > > > > > This pediatrician may simply be aware that this certain HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > > the question, but don't shoot the messenger. > > > > > > > > > --------------------------------- > Get your own web address for just $1.99/1st yr. We'll help. Small Business. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 Greetings... I'm an SLP and I try to keep up with this posting because a lot of good ideas are shared here. This posting on insurance issues intrigued me and I thought I would reply... Basically, anyone can use those billing codes, but typically, insurance companies have a list of acceptable billers (e.g., anyone can bill using the low muscle tone code, but only PT and OT may get reimbursed). Also, insurance companies tend to track codes and the people who are billing them. If they find an SLP is using an " atypical " code, they may request an audit (which, yes, is similar to an IRS audit). So, this is tricky business. Personally, I tend to look up those codes I am considering (either through the insurance companies website or on my professional website) before billing if it is an " atypical " code. Most professions have a list of codes that are accepted for that profession. Hope this helps!! J. @...: jaemegcola@...: Thu, 12 Oct 2006 06:48:54 -0700Subject: Re: [ ] Re: insurance issues I know that the PT and the OT use the same code of Low muscle tone, and my daughter's SLP uses many methods during the session that I would consider OT. A good bit of time during her speech session is spent performing exercises to strengthen her mouth. She is a great SLP but she just feels that using what she considers to be an OT code is not something she will do. She just reminds me to be careful of what I am reading from this group. Also, I don't think there are codes designated just for speech, or OT, I assumed the codes were to describe a diagnosis. She uses the code for verbal apraxia and the OT uses the code for muscle tone, the OT could very well use the apraxia code because they go hand in hand. myjunkytrash <myjunkytrash@...> wrote: I will find out for sure but they might be what your SLP would consider " OT codes. " I don't think it's unethical though because the SLP isn't claiming to be an OT, so the insurance company knows she is an SLP and let's face it--those insurance companies know how to look out for themselves! Maybe you could point this out to your SLP. She isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and the services she is providing (speech therapy) and if your child does have issues that fall under the codes. Apraxia requires an OT approach to speech therapy because our kids aren't aware of their mouths and don't have full control over moving their mouths and tongues. There might also be some SI-related problems or low tone issues too--all of which can affect speech. There really is a big overlap, I think. How is your SLP treating your child? If she isn't using oral-motor techniques then she might feel uncomfortable using those codes, but more importantly, she might not be the best fit for your child...> > > > > > > > This pediatrician may simply be aware that this certain HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > > the question, but don't shoot the messenger. > >> > > > > > > ---------------------------------> Get your own web address for just $1.99/1st yr. We'll help. Small Business.> > [Non-text portions of this message have been removed]>__________________________________________________Do You ?Tired of spam? has the best spam protection around http://mail. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2006 Report Share Posted October 12, 2006 The code for Apraxia is 784.69 Gordon <momster451@...> Sent by: cc: @yaho Subject: Re: [ ] Insurance issues ogroups.com 10/11/2006 10:09 AM Please respond to Is there a separate code for " dyspraxia " ? The doctor stated that my son was dyspraxic, but then neglected to use the code for it. alpy2@... wrote: The doctor is wrong about apraxic kids not being able to speak necessarily. The doctor is assuming that apraxia means total lack of speech (from Latin root " a " which means " absence of " ). Technically, he's correct. Technically, a child who can speak but not properly would be " dyspraxic. " But in the U.S., these terms are interchangeable (in Britain I believe they tend to make this distinction that we Americans usually don't). Perhaps your doctor would be more comfortable with a diagnosis of " dyspraxia. " Hope this helps! Sandy, Illinois (alpy2@...) Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA reauthorization) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2006 Report Share Posted October 13, 2006 The neurologist used 783.40 and 758.9. I have to ask what our OT is using; United calls it " medical services " and doesn't use a code on my explanantion of benefits forms they send me in the mail. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2006 Report Share Posted October 13, 2006 The neurologist used 783.40 and 758.9. I have to ask what our OT is using; United calls it " medical services " and doesn't use a code on my explanantion of benefits forms they send me in the mail. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2007 Report Share Posted December 16, 2007 mariapepple@... insurance issues Sorry to take so long to respond, but I would like to know if anyone has helpful strategies for getting insurance companies to pay for speech therapy. So many say they will only pay for restorative speech Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2008 Report Share Posted September 20, 2008 Has anyone had success in getting their insurance to cover Dr. G as an " in-network provider " ? We have Anthem Blue Cross. Thank you, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2008 Report Share Posted September 20, 2008 Have you gone online and checked your provider directory? We don't have Anthem but we have Blue Cross/Blue Shield Federal Plan. From what I understand from (you should probably call the office to confirm), if the billing goes through Blue Shield, it's accepted. HTH, Robyn > From: <ljburns83@...> > Subject: insurance issues > > Date: Friday, September 19, 2008, 11:05 PM > Has anyone had success in getting their insurance to cover > Dr. G as > an " in-network provider " ? We have Anthem Blue > Cross. > > Thank you, > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2008 Report Share Posted September 20, 2008 He doesn't take Blue Cross so you aren't likely going to be able to get him paid as in network. You might try the autism-insurance list, though. i think someone else tried to do it once by telling them he's the only person that was able to help their child. I don't know what became of it. Cheryl On Sep 20, 2008, at 7:23 AM, Robyn & Greg Coggins wrote: > Have you gone online and checked your provider directory? We don't > have Anthem but we have Blue Cross/Blue Shield Federal Plan. From > what I understand from (you should probably call the > office to confirm), if the billing goes through Blue Shield, it's > accepted. > > HTH, > > Robyn > > > > >> From: <ljburns83@...> >> Subject: insurance issues >> >> Date: Friday, September 19, 2008, 11:05 PM >> Has anyone had success in getting their insurance to cover >> Dr. G as >> an " in-network provider " ? We have Anthem Blue >> Cross. >> >> Thank you, >> > > ------------------------------------ > > Responsibility for the content of this message lies strictly with > the original author(s), and is not necessarily endorsed by or the > opinion of the Research Institute, the Parent Coalition, > or the list moderator(s). > Quote Link to comment Share on other sites More sharing options...
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