help with insurance coverage for child with chromosomal deletion & apraxia

[Guest guest]

Hi everyone,

There have been posts in the past about dealing with insurance. They have been

very helpful! However, I am in a battle with insurance over speech therapy for

my 3 year old son who has a chromosomal deletion (no documented syndrome

associated with it...very rare) resulting in apraxia and was wondering if anyone

has dealt with similar issues with insurance and could offer any

suggestions/things that have worked for them.

Basically, we are trying to get our insurance to cover weekly speech therapy

(this is in addition to the therapy he is receiving in special ed preschool in

case you were wondering). As of now, insurance will only cover 20/year. Also

trying to get a gap exception to get coverage through a therapist that can also

provide Assistive Tech therapy/training. As of now, there is only 1 provider

in network that does speech and they do not do AT. So we'd have to go out of

network unless they make an exception. My son is 3 1/2 and is non-verbal so we

are really trying to push the therapy now.

We have letters from several doctors (geneticist, develop ped, ped). I need to

write a letter to go along with this. , your book very helpful for my

first attempt....to even get them to cover therapy at all. Now need to get

more detailed though.

Any thoughts or tips appreciated.

Thanks!

[Guest guest]

Hi ,

My son has a rare chromosomal duplication and we were in the same boat.

After fighting and fighting, the insurance company stood it's ground and

wouldn't cover speech therapy at all for him. We finally applied for a Small

Steps in Speech grant and were approved for one year for one session a week.

It has been an absolute Godsend. There is also a grant program through

UnitedHealthcare Children's Foundation and we received a grant from them

that has helped with OT and PT that our insurance will only cover when they

feel like (which is one here and one there and deny deny deny otherwise...

frustrating). The links for both are:

http://smallstepsinspeech.org/

http://www.uhccf.org/

If you have any questions, let me know but I highly recommend applying for

these to anyone who either has insurance that won't cover any or won't cover

all of the needed therapies. We were so spent and exhausted trying to get

our son his therapies and after tons of sleepless nights and googling I

found these grants. One was suggested by another parent on the Apraxia

Facebook page.

On Wed, Feb 23, 2011 at 3:00 PM, stephclark14 <stephclark14@...>wrote:

>

>

> Hi everyone,

>

> There have been posts in the past about dealing with insurance. They have

> been very helpful! However, I am in a battle with insurance over speech

> therapy for my 3 year old son who has a chromosomal deletion (no documented

> syndrome associated with it...very rare) resulting in apraxia and was

> wondering if anyone has dealt with similar issues with insurance and could

> offer any suggestions/things that have worked for them.

>

> Basically, we are trying to get our insurance to cover weekly speech

> therapy (this is in addition to the therapy he is receiving in special ed

> preschool in case you were wondering). As of now, insurance will only cover

> 20/year. Also trying to get a gap exception to get coverage through a

> therapist that can also provide Assistive Tech therapy/training. As of now,

> there is only 1 provider in network that does speech and they do not do AT.

> So we'd have to go out of network unless they make an exception. My son is 3

> 1/2 and is non-verbal so we are really trying to push the therapy now.

>

> We have letters from several doctors (geneticist, develop ped, ped). I need

> to write a letter to go along with this. , your book very helpful for my

> first attempt....to even get them to cover therapy at all. Now need to get

> more detailed though.

>

> Any thoughts or tips appreciated.

> Thanks!

>

>

>

>

[Guest guest]

See if there is a " Service Availability " type of form that allows you to

state that there is NOT any other appropriate SLP within your ins network.

Warmest wishes,

Barbara

Barbara A. , M.S., CCC-SLP

CEO/ Help Me Speak, LLC

<http://www.helpmespeak.com/> http://www.helpmespeak.com

(o) 410-442-9791 (f) 410-442-9783

2500 Wallington Way; Suite 103

Marriottsville, MD 21104

Call me with any questions about NutriiVeda!

From:

[mailto: ] On Behalf Of stephclark14

Sent: Wednesday, February 23, 2011 4:01 PM

Subject: [ ] help with insurance coverage for child with

chromosomal deletion & apraxia

Hi everyone,

There have been posts in the past about dealing with insurance. They have

been very helpful! However, I am in a battle with insurance over speech

therapy for my 3 year old son who has a chromosomal deletion (no documented

syndrome associated with it...very rare) resulting in apraxia and was

wondering if anyone has dealt with similar issues with insurance and could

offer any suggestions/things that have worked for them.

Basically, we are trying to get our insurance to cover weekly speech therapy

(this is in addition to the therapy he is receiving in special ed preschool

in case you were wondering). As of now, insurance will only cover 20/year.

Also trying to get a gap exception to get coverage through a therapist that

can also provide Assistive Tech therapy/training. As of now, there is only 1

provider in network that does speech and they do not do AT. So we'd have to

go out of network unless they make an exception. My son is 3 1/2 and is

non-verbal so we are really trying to push the therapy now.

We have letters from several doctors (geneticist, develop ped, ped). I need

to write a letter to go along with this. , your book very helpful for my

first attempt....to even get them to cover therapy at all. Now need to get

more detailed though.

Any thoughts or tips appreciated.

Thanks!

[Guest guest]

Hi, ,

For my daughter, we used a back door approach. We have insurance through my

husband's company. I had a list of diagnoses, and asked my husand to get the

HR people to ask the insurance company if any of those are covered diagnoses

under our insurance policy. They were, so when I appealed the denial, I

quoted the name of the person at the insurance company who said it was

covered, and added other documentation. They paid the claims for the next

three months, but I have to prove the need again every three months through

a progress report from her therapists.

Here is a blog post I wrote on How to Make a Successful Insurance Claim

based on my experience with the appeals process we've been through a few

times:

http://busyhomeschooler.com/?p=182

[ ] help with insurance coverage for child with

chromosomal deletion & apraxia

Hi everyone,

There have been posts in the past about dealing with insurance. They have

been very helpful! However, I am in a battle with insurance over speech

therapy for my 3 year old son who has a chromosomal deletion (no documented

syndrome associated with it...very rare) resulting in apraxia and was

wondering if anyone has dealt with similar issues with insurance and could

offer any suggestions/things that have worked for them.

Basically, we are trying to get our insurance to cover weekly speech

therapy (this is in addition to the therapy he is receiving in special ed

preschool in case you were wondering). As of now, insurance will only cover

20/year. Also trying to get a gap exception to get coverage through a

therapist that can also provide Assistive Tech therapy/training. As of now,

there is only 1 provider in network that does speech and they do not do AT.

So we'd have to go out of network unless they make an exception. My son is 3

1/2 and is non-verbal so we are really trying to push the therapy now.

We have letters from several doctors (geneticist, develop ped, ped). I

need to write a letter to go along with this. , your book very helpful

for my first attempt....to even get them to cover therapy at all. Now need

to get more detailed though.

Any thoughts or tips appreciated.

Thanks!