Re: Insurance denied him additional therapy

[Guest guest]

I am sorry this happened. What was his diagnosis (submitted to insurance)? I

thought apraxia is clearly now a medical condition. I am very upset a this as

well! We will be going down the insurance path when EI ends soon..yikes.

Iveta

[Guest guest]

Has your son been diagnosed with apraxia?� We too have�BC/BS (federal) and

my 3.8 yr old son has been receiving private therapy for past six months�w/o

any questions from the insurance co.�I knew right off that he would be

entitled to 50 annual visits as indicated on the benefits booklet. �I have

tried to be proactive and obtained a diagnosis for apraxia�because I am

concerned that they will �try to say it is not medically necessary, but so

far, it has not been a problem. �We have also had just about every genetic

test you could think of w/o any problems and no out�of pocket cost.

[Guest guest]

I hear your frustrations and can understand what you're going through!� Our

insurance put us thru alot too and then denied speech services all together

unless it is rehablitive.� So basically we are paying out of pocket for our

son to get therapy 2x a month with a private therapist (he also gets therapy 3x

a week at preschool).� But, our 2 year old son also isn't talking as he should

be and and he is about to start therapy also.� We qualified for a reduced fee

of $57 per half hour session (they normally charge $95 a half hour).� It is so

frustrating that insurnace won't cover it.� I'm happy for you that you do get

some coverage but I know sometimes, alot of the times-it's not enough that they

offer you!� Good luck and just wanted to let you know, I did read your post

and wanted to respond!

[Guest guest]

Becky- Is this private BC/BS you have? Or what you mean by " federal " is not

private..don't know what you would call it. Do you get private speech therapy

from an ST of your choice (at home or other) OR do you get your insurance

covered speech thru hospitals designated by the insurance?

thank you,

Iveta

>

> Has your son been diagnosed with apraxia?� We too have�BC/BS (federal) and

my 3.8 yr old son has been receiving private therapy for past six months�w/o

any questions from the insurance co.�I knew right off that he would be

entitled to 50 annual visits as indicated on the benefits booklet. �I have

tried to be proactive and obtained a diagnosis for apraxia�because I am

concerned that they will �try to say it is not medically necessary, but so

far, it has not been a problem. �We have also had just about every genetic

test you could think of w/o any problems and no out�of pocket cost.

>

[Guest guest]

I know there are different BC/BS plans as I am a Texas state employee and have

Texas BC/BS but my son is covered under my husband's insurance and he is a

federal employee and�has Federal BC/BS basic plan. Under the plan we must use

preferred providers.� The speech therapist that my son has been seeing is

considered a preferred provider and our copay is $25 but�his SLP waives the

copay.�His SLP has her own practice as well as all of the others on the list

of preferred providers to choose from.�She does not offer home therapy though.

I do recall when she performed his initial assessment, she said she had to be

very careful into how she submitted the insurance claim to avoid it being

rejected.� If there is any mention of developmental delay, they may reject the

claim as they would think that he would eventually just catch up which is

ridiculous.

[Guest guest]

Check out the 2004 Michigan Insurance Commission ruling against BCBS....if your

son's claims have been submitted under the apraxia code, you'll find this very

informative and helpful. Good luck!

>

> And I couldn't help but cry at the end of the phone call... Blue Cross Blue

Shield just denied my son getting additional speech therapy (he had 30 sessions

this year), claiming it's not medically necessary. This has been dragging on for

well over 2 months (originally sent in 7/27, but they claim to have not gotten

it and that they first received paperwork on 8/6). They pushed it to priority,

then urgent status, then paused everything while they requested a ton of info

from the dr. They told me I can appeal it with another letter from my dr, but I

have no doubt they will drag it out another 60 days (12/19 or later), and I get

30 sessions in January.

>

> At this point, I've spoken with an advocate, but was holding off doing

anything until BCBS gave an answer. I don't know what they'll do for me. His

therapist usually charges $65/ half hour in cash, but offered a rate of $50

since I can't swing the higher rate, and I've been going for almost 1 1/2 yrs. I

am waiting for a call back from his former EI therapist. If I offer her cash,

she may be willing to work a little longer than his current therapist. I

wouldn't mind the tax break of paying regularly, but more speech is important

than getting money back at the end of the year.

>

> I guess this is more of a rant than anything. Thanks for listening...

>

[Guest guest]

thanks for explaining it more in detail.

My son has codes that are NOT developmetal delay codes..they are 784.6, 784.5 in

the speech area (has a few other codes for sensory and PT also) so are these

codes pretty much be okay with insurance for getting speech therapy?

IF we get re-evaluated- they will drop any code that has to do with him being

behind receptively. He is up to speed, just now expressive delay- no words at

all!

OR should I go for an evaluation and get " verbal apraxia " code for insurance?

So should we NOT get re-evaluated for insurance purposes (we get a new insurance

in a few months) and keep the codes above?

anyone who can help with this question would be appreciated- thanks!!

I hope I am explaining my self well and you understand my question- of basically

WHAT are the best codes to use to get them speech through insurance?

thanks!

Iveta

>

> I know there are different BC/BS plans as I am a Texas state employee and have

Texas BC/BS but my son is covered under my husband's insurance and he is a

federal employee and�has Federal BC/BS basic plan. Under the plan we must use

preferred providers.� The speech therapist that my son has been seeing is

considered a preferred provider and our copay is $25 but�his SLP waives the

copay.�His SLP has her own practice as well as all of the others on the list

of preferred providers to choose from.�She does not offer home therapy though.

I do recall when she performed his initial assessment, she said she had to be

very careful into how she submitted the insurance claim to avoid it being

rejected.� If there is any mention of developmental delay, they may reject the

claim as they would think that he would eventually just catch up which is

ridiculous.

>

[Guest guest]

Iveta> I've seen codes 784.69 (apraxia), 784.5 (severe artic deficits with

suspected apraxia), 781.3 (oral hypotonia), and 784.6 (expressive language

deficits) written on his previous evals. I did not look up the ICD codes today

for their exact meaning, only wrote what was listed next to the codes in the

evals.

Good luck.

>

> thanks for explaining it more in detail.

>

> My son has codes that are NOT developmetal delay codes..they are 784.6, 784.5

in the speech area (has a few other codes for sensory and PT also) so are these

codes pretty much be okay with insurance for getting speech therapy?

>

> IF we get re-evaluated- they will drop any code that has to do with him being

behind receptively. He is up to speed, just now expressive delay- no words at

all!

>

> OR should I go for an evaluation and get " verbal apraxia " code for insurance?

>

> So should we NOT get re-evaluated for insurance purposes (we get a new

insurance in a few months) and keep the codes above?

>

> anyone who can help with this question would be appreciated- thanks!!

>

> I hope I am explaining my self well and you understand my question- of

basically WHAT are the best codes to use to get them speech through insurance?

>

> thanks!

> Iveta

>

>