Verbal Apraxia and Hearing Loss

July 21, 2009

Well... I was denied on my appeal to BCBS regarding speech therapy for Verbal

Apraxia. The private plan which is administered by BCBS (Blue Cross Blue Shield)

has a clause which states that speech therapy for a dependent older than 9 years

old can only be considered if it is a result of an injury or accident OR

rehabilitative. My child is 11yrs old with Down Syndrome, Hypotonia, Verbal

Apraxia, Sensorimotor Deficit, Chronic Otitis media, Sleep Apnea and

Coordination disorder. My child looks worse on paper! I appealed the initial

denial of coverage with a medical necessity letter from his ENT as my child has

hearing loss directly related to Otitis media and a permanent perforation in his

right ear. A medical nec. letter from his speech therapist stating diagnose of

Verbal Apraxia. A letter of medicla nec. from Pediatrician stating he needs to

be able to tell his medical service providers what his medical needs are

therefore speech therapy med. nec.

I wish to request a clarification on BCBS denial to my appeal as they state his

speech therapy " appears " to be related to developmental care, which of course

they don't cover. My question is, does hearing loss as result of an injury such

as a perforated ear drum, affect someone with Verbal Apraxia and how? Is speech

therapy medically necessary to rehabilitate speech that is lost due to hearing

loss in an individual with Verbal Apraxia?

Anyone with advice?

July 23, 2009

Apraxia is a lifelong condition; HOWEVER, the speech therapy is " rehabilitative "

because the goal is to either get your child talking or develop a language

communication system, which you could still use a speech therapist to teach your

child sign language (good premise)through the help of a speech therapist. If the

insurance company does not pay for your child to be treated for this condition,

then they are " disabling " your child for life. Does your insurance provide

disability and if not, would you meet the income requirements to get SSI for

your child (assuming you live in the USA) and then your child gets automatic

medicaid (most states) and can get the services.

Social Security can tell you the maximum amount monthly that you can make and

still get SSI for your child. If you are eligible for even $1, then they give

you medicaid. I think for a married couple, it is $3000 or more (it changes

every year). If you are married and one of you with all children included would

meet the eligibility requirements, then you can file a " Complaint for Separate

Maintenance " in Superior Court of your county and then, your child would be

eligible.

Does this help any?

July 24, 2009

I don't know if I believe that . I think that epilepsy and seizures have a

lot to do with apraxia and I believe that children can improve or recover

completely if the abnormal electric activity in the brain can be lessened or

ceased. I am beginning to learn that there are gastrointestinal relationships

to epilepsy and that a gluten free diet can improve symptoms significantly in

some people.

>

> Apraxia is a lifelong condition; HOWEVER, the speech therapy is

" rehabilitative " because the goal is to either get your child talking or develop

a language communication system, which you could still use a speech therapist to

teach your child sign language (good premise)through the help of a speech

therapist. If the insurance company does not pay for your child to be treated

for this condition, then they are " disabling " your child for life. Does your

insurance provide disability and if not, would you meet the income requirements

to get SSI for your child (assuming you live in the USA) and then your child

gets automatic medicaid (most states) and can get the services.

> Social Security can tell you the maximum amount monthly that you can make and

still get SSI for your child. If you are eligible for even $1, then they give

you medicaid. I think for a married couple, it is $3000 or more (it changes

every year). If you are married and one of you with all children included would

meet the eligibility requirements, then you can file a " Complaint for Separate

Maintenance " in Superior Court of your county and then, your child would be

eligible.

> Does this help any?

>

July 24, 2009

Yes thank you. I am however requesting a clarification on the denial from BCBS

as to why they deem speech therapy for Verbal Apraxia as developmental care.

Additionally having the private insurance address hearing loss impacting

communication disorder and loss of language which speech therapy would

rehabilitate.

Its worth a shot I think..

I am relatively new to this group and I am very grateful for all the support and

information the members offer. I do not feel alone in my plight with my son of

special needs.

________________________________

From: <agirlnamedsuess@...>

Sent: Thursday, July 23, 2009 3:53:14 PM

Subject: [ ] Re: Verbal Apraxia and Hearing Loss