Re: Aetna-

[Guest guest]

--with an apraxia code--784.69 Aetna will cover it with letter of medical

necessity from doctor, ASHA definition of apraxia as a neurological disorder

--NOT developmental one as Aetna diabolically and wrongly of course has it

listed under exclusions. NOT SO--it can't be--but be careful--representatives

are also misinformed and will tell you a lot of stories that are not true. So

you need to appeal if you've been denied coverage for apraxia but do it the way

we did it.

So yes with evaluation and SLP definition from ASHA as well as recommendations

for treatment 3-5 times a week; progress reports and of course doctor's letter

of medical necessity stating the same thing---and your letter explaining it all

and citing ASHA , SLP, and doctor to make your point--our daughter's apraxia

treatment was covered. Also if she needs PROMPT_-doctor says so--plus SLP--and

you may get this covered as in network--since there are usually no in network

PROMPT trained therapists and you have to go out of network--distance also plays

into it--can't be too far from you and so you may even get full coverage as

in-network,. We didn't go for that one, because between OT and speech and

chiropractic by mid-year we get full out of network coverge anyway--if it is a

medical necessity--which the doctor's letter provides.

Our former company had NO speech coverage for kids--so the Aetna policy was

it--and with all of the above we got it covered. But you may need to appeal. We

sent everything with the first claims and they saw they had to cover it and

didn't beat around the bush with their faulty definition. Everyone citing ASHA

made them realize they shouldn't play around with those claims. Good luck!

Elena

________________________________

From: sarah marshall <sarah0248@...>

primabullock@...; eileenduffy@...;

Sent: Wed, July 28, 2010 6:07:04 PM

Subject: [ ] Aetna

I have Aetna and it is horrible. While they say that they cover " speech

therapy " , the fact is: They don't. They cover it only if it is

rehabilitative (like if there was a stroke)--not habilitative or if there is

some physical anomaly like cleft palate. You can go to www.aetna.com and

look for yourself at their Clinical Policy Bulletin on Speech therapy.

Click on the Individual and Families tab I think it is and there will be a

medium size square kind of in the middle of the page that says Clinical

Policy Bullentins. Click on it and then choose the Medical one (there are 3

and I can't remember what they all are). And then on the following page

there will be a space to type in the number of the bulletin or key words.

Type in " 0243 " (or speech therapy) and their policy will pop up. I have

gone round and round with Aetna trying to pin them down on what they will

cover and no one will tell me except to point me to this bulletin. I have

had more than one speech therapist in my area say, " Oh you have Aetna? They

are notorious for NOT covering speech therapy! " .

I copy and pasted the link--you can try it to see if it will bring you

directly to the bulletin. Otherwise just follow my instructions

http://searchx.aetna.com/_layouts/search/cpb2.aspx?k=0243 & selectedIndex=0 & s=All+\

sources & pt=SDAV%3ahref%2cContains%2chttp%3a%2f%2fwww.aetna.com/cpb/medical/data/\

%2cAnd%2c & wd=+where+%22URL%22+Contains+http%3a%2f%2fwww.aetna.com/cpb/medical/da\

ta/ & RefURL>

=

My daugher who turned 2 in June is now receiving services from our school

district and the University (of Minnesota). A friend suggested that I call

the local university's graduate program for speech, hearing and language...I

did and was placed on the waiting list and got in about 3 months later.

They charge $40 per session and do a sliding scale for those that qualify.

My daughter goes twice a week to the University. A graduate student is her

therapist and she is directly supervised for a licensed speech pathologist.

It's a great option for those whose insurance will not cover or those that

do not have insurance.

Good luck!

--

" Birth is not only about making babies. Birth is about making mothers ~

strong, competent, capable mothers who trust themselves and know their inner

strength. "

- Barbara Katz Rothman