Re: insurances- do they cover speech therapy?

[Guest guest]

Try Early Intervention. Since he's under three they are supposed to help

and its free. But you have to keep on top of things with them. My son

almost fell through the cracks with them. The therapist we had was fantastic

though. Worth the wait.

[Guest guest]

It depends more on the type of plan you have rather than the company. Diagnosis

codes are very helpful for insurance reimbursement and the therapist will need

to use one when they give you an invoice. Since he's can still meets the age

requirement for Early Intervention, that's a good place to start.

>

> hi- wondering if and when we get insurance through Oxford or United if we can

actually have private speech covered through them. I understand it is covered if

the child has CP or other clinical issues and needs speech...but wjat about

plain apraxia?

>

> Does anyone have experience in New Jersey with these insurances?

>

> My son just turned 2, and we don't have formal diagnosis..but I can get one

probably if needed for the insurance to have it in black and white that he has

apraxia...or is it good to get another code..which are covered by insurances?

(yes, have the late talker book, but wanted to hear about recent NJ

experiences).

>

> I really appreciate any info from parents- thanks!

> Iveta

>

[Guest guest]

im not in NJ, but at first they denied saying they need " medical necessity " and

after we fought they approved under the code of too many ear infections, which

is not the case....

________________________________

From: lucy4gets <lucy2max@...>

Sent: Tuesday, September 8, 2009 10:12:45 AM

Subject: [ ] insurances- do they cover speech therapy?

 

hi- wondering if and when we get insurance through Oxford or United if we can

actually have private speech covered through them. I understand it is covered if

the child has CP or other clinical issues and needs speech...but wjat about

plain apraxia?

Does anyone have experience in New Jersey with these insurances?

My son just turned 2, and we don't have formal diagnosis..but I can get one

probably if needed for the insurance to have it in black and white that he has

apraxia...or is it good to get another code..which are covered by insurances?

(yes, have the late talker book, but wanted to hear about recent NJ experiences)

..

I really appreciate any info from parents- thanks!

Iveta

[Guest guest]

Can you give me the procedure codes they are using? Sometimes a clerical error

by one number will deny insurance.

For instance, they denied us on the code for Apraxia 784.69 claiming its

developmental which we all know it's NOT, but they approved the therapy for the

code for Language processing disorder 388.43.

A great code to use if you have a child with apraxia is 781.3 which is " lack of

muscle coordination /coordination disorder. " This shows a physical diagnosis,

which is typically covered, versus a developmental diagnosis, which is typically

not covered. codes 781.3 (dyspraxia/coordination disorder I believe an OT code)

and 315.32 (mixed receptive-expressive language disorder) may also work. Talk to

your SLP about the procedure codes.

It's a rollercoaster ride when you deal with the insurance companies. Everyone

has their own set of rules. In order to get your insurance company to comply

with speech therapy all evaluation and treatment reports should be stated in

medical terms, not educational goals.

A speech pathologist (not speech therapist) should have given you a written

evaluation report stating what tests were given and the medical diagnosis for

your child with a treatment plan.

Your pediatrician cannot evaluate but recommend a specialist to go to for

further evaluation.

Good Luck!

[Guest guest]

more questions..I have read all the replies- thank you! so it sounds like I will

have to " coax " my speech pathologist at the children's hospital to put through

the proper codes..I hope this can be done when the time comes. My son doesn't

have anything severe..

Question: can we use that he has hypotonia in facial muscles? (for the private

insurance speech coverage)

I do not have codes at the moment- somebody asked..my son is 2 and we do get

early intervention- but I am also on the state's insurance and have unlimited

speech therapy through medicaid...so when my husband gets insurance through his

job will I be able to KEEP these therapies-

Question: would I have to reapply for medicaid help? (or does it just continue

once he is on it?)

I would love to get therapies actually aimed at apraxia privately PAID by

insurance,since my son desperately needs it, and the ones we get outside of EI

are not adressing apraxia.

any more advice is greatly appreciated, thank you!

Iveta

In , " howdiette " <mulholland34@...> wrote:

>

> Can you give me the procedure codes they are using? Sometimes a clerical

error by one number will deny insurance.

>

> For instance, they denied us on the code for Apraxia 784.69 claiming its

developmental which we all know it's NOT, but they approved the therapy for the

code for Language processing disorder 388.43.

>

> A great code to use if you have a child with apraxia is 781.3 which is " lack

of muscle coordination /coordination disorder. " This shows a physical diagnosis,

which is typically covered, versus a developmental diagnosis, which is typically

not covered. codes 781.3 (dyspraxia/coordination disorder I believe an OT code)

and 315.32 (mixed receptive-expressive language disorder) may also work. Talk to

your SLP about the procedure codes.

>

> It's a rollercoaster ride when you deal with the insurance companies.

Everyone has their own set of rules. In order to get your insurance company to

comply with speech therapy all evaluation and treatment reports should be stated

in medical terms, not educational goals.

>

> A speech pathologist (not speech therapist) should have given you a written

evaluation report stating what tests were given and the medical diagnosis for

your child with a treatment plan.

>

> Your pediatrician cannot evaluate but recommend a specialist to go to for

further evaluation.

>

>

>

> Good Luck!

>