Insurance Wording - need guidance

[Guest guest]

Hello all.

Our insurance provider is about to change and, although our current provider has

covered Speech THerapy with no problems, our new insurance might not be so easy.

Wanted to post my new coverage details in the hopes someone has seen this

language before and been able to overcome it. We haven't yet been denied, but

we haven't fully switched over yet and I'm preparing my pre-determination

documentation as we speak.

New policy states: Insurance covers unlimited speech therapy for REHABILITATIVE

services but will not cover ST for developmental delays. Additionally, they

will not cover ST for:

- Developmental disability: disability that occurred before 19 & has a

substantial disability which results from mental retardation, cerebral palsy,

epilepsy or other neurological disorder AND which is diagnosed by a Physician as

a permanent or long-term continuing condition.

This wording scares me b/c although we know apraxia isn't developemntal

delay/disability, it is neuro-based and long-term. I am concerned that they've

covered all potential bases so as NOT to cover services. I can say it's not

developmental, but when I say it's neuro-based and requires intensive therapy,

etc I'm afraid they'll knock me for it.

Thoughts? Similar experiences? I have letters of necessity from ST and

pediatrician, the ASHA definition and template letters from Cherab archives, but

the wording stumps me on the angle I can take.

Any input appreciated.

Sharon