Re: Insurance pay for treatment?

[Guest guest]

Aetna must have a new marketing team on board. Several of my NJ

doctors have notes on their office windows stating " since we could not

reach a mutual agreement with Aetna, we will no longer accept their

plans " . It seems they are cutting back many treatments, including

speech therapy. I would contact your state insurance department to

ask for a review of Aetna's exclusions policy. Once a complaint is

filed with the state, they are required to do a full investigation.

Insurance businesses and its executives have lost a lot of profit

since 9/11 and need to find ways to catch up to their losses by

charging the consumer. Unfortunately, the consumer in this case are

children with speech deficits.

all the best,

Joanne

P.s. contact your local school district (mayor's office) and ask them

if they have a discretionary fund they can use to supplement your

child's speech therapy since the school cannot provide the appropriate

therapy and your insurance refuses to pay for apraxic child.

[Guest guest]

>

> Our insurance company, Aetna, has a specific clause in our policy

> stating that they will not cover speech therapy for children

diagnosed

> with verbal apraxia unless due to a brain injury or disease. My

> husband's company, Panasonic, agreed to look into this to see if they

> could change their policy but they said that they have not found any

> similar large employer insurance plans that cover speech therapy for

> apraxia.

>

> If I can prove that other large employers' (like Panasonic) insurance

> plans do cover, we may have a chance to change their policy. So can

> anyone provide input about their employer and their insurance covers

> treatment for apraxia? Would greatly appreciate any help.

>

I work for Cendant Corporation (a very large co. you have probably

never heard of) and am insured through Cigna. They cover 60 days of

therapy under our short term rehabilitation coverage as long as it

is " medically necessary " , apparently regardless of cause. And because

it is " days " not sessions, I have been told that if I can get OT/PT

scheduled on the same day at the same facility, it would not double

count, and still only be 1 " day " , if you know what I mean.

Hope that helps.

Sue

[Guest guest]

We have Aetna and they cover our son's Speech Therapy for Apraxia with a

letter of medical necessity written by our developmental pediatrician. They

cover 60 visits annually. My husband's employer is the State of NJ.

" sloringcrane "

<sloringcrane@...>

Sent by: cc:

@yaho Subject:

[ ] Re: Insurance pay for treatment?

ogroups.com

06/09/2006 12:28 PM

Please respond to

>

> Our insurance company, Aetna, has a specific clause in our policy

> stating that they will not cover speech therapy for children

diagnosed

> with verbal apraxia unless due to a brain injury or disease. My

> husband's company, Panasonic, agreed to look into this to see if they

> could change their policy but they said that they have not found any

> similar large employer insurance plans that cover speech therapy for

> apraxia.

>

> If I can prove that other large employers' (like Panasonic) insurance

> plans do cover, we may have a chance to change their policy. So can

> anyone provide input about their employer and their insurance covers

> treatment for apraxia? Would greatly appreciate any help.

>

I work for Cendant Corporation (a very large co. you have probably

never heard of) and am insured through Cigna. They cover 60 days of

therapy under our short term rehabilitation coverage as long as it

is " medically necessary " , apparently regardless of cause. And because

it is " days " not sessions, I have been told that if I can get OT/PT

scheduled on the same day at the same facility, it would not double

count, and still only be 1 " day " , if you know what I mean.

Hope that helps.

Sue

[Guest guest]

By any chance is your insurance through Aetna a " State Health

Benifit Plan " . I ask because, different insurance companies offer

different plans. Case in point.. we have Horizon BC/BS, (the state

health benift plan) and we cannot get them to pay for Speech-

unless " its a loss of previously acquired speech " , such as a head

injury,or stroke that would cause you to lose your speech, then they

cover ST.

A friend of mine, has twins, both apraxic, she has Horizon BC/BS,

(non SHPB) and they covered speech therapy for the her twins.

>

> We have Aetna and they cover our son's Speech Therapy for Apraxia

with a

> letter of medical necessity written by our developmental

pediatrician. They

> cover 60 visits annually. My husband's employer is the State of NJ.

[Guest guest]

>

> By any chance is your insurance through Aetna a " State Health

> Benifit Plan " . I ask because, different insurance companies offer

> different plans. Case in point.. we have Horizon BC/BS, (the state

> health benift plan) and we cannot get them to pay for Speech-

> unless " its a loss of previously acquired speech " , such as a head

> injury,or stroke that would cause you to lose your speech, then they

> cover ST.

>

> A friend of mine, has twins, both apraxic, she has Horizon BC/BS,

> (non SHPB) and they covered speech therapy for the her twins.

>

>

What benefits are or are not covered are often specifically negotiated

by your employer.

Sue

[Guest guest]

I don't think we have a " state health plan " . The VP of HR at

Panasonic said that they have an employer specific plan. But when

they " researched " , they found no other similar sized employers like

Panasonic cover speech therapy for apraxia. However, their " research "

was to ask some consultants. They never actually benchmarked against

any companies.

Thanks everyone for their input. I'm going to complete the complain

form thru NJ. It's just appalling that insurance companies won't

cover any costs.