I would save this info! Mama

[Guest guest]

Elena Danaila wrote:

>

> Hi ,

> Welcome and I just want to chime about of the insurance covering

> speech. The fact is, if it is a medical diagnosis, like apraxia, which

> is by definition a neurological disorder similar to an adult who was

> either struck by lightning or a stroke, some sort of injury to the

> brain and can no longer motor plan their speech and need to relearn

> motor planning.

>

> In the case of children of course the reasons are not known, but the

> symptoms are the same, lack of speech motor planning abilities and

> yes, of course the treatment for both cases is speech therapy.

> However insurance companies try to hide behind the no speech covered

> if it did not exist previously and was lost. Of course this is an

> absurd demand to place on a child who obviously has not had the chance

> to learn to speak yet, but the same neurological disorder can exist as

> in an adult. Another thing they say is no speech covered for

> children. Not so again, they may not cover lisps and minor

> articulation issues which are considered developmental in nature and

> sometimes do re mediate even without speech therapy. But

> unfortunately apraxia does NOT fall in this category and it does NOT

> go away on its own. In fact it needs a very rigorous, frequent motor

> planning intervention 1:1 to improve and there is plenty of research

> supporting this.

>

> Here's what we did: we got the SLP who evaluated her to write the ASHA

> definition--cut and paste_ in the report defining apraxia as a

> neurological disorder. We then got the doctor to write the letter of

> medical necessity, again, including the same cut and paste definition

> and clearly stating that speech therapy is needed to re mediate it.

> And we also attached the full ASHA document in our request for speech

> therapy and it was covered no problem.

>

> Just be sure the ICD -9 784.69 code is included along with the exact

> ASHA definition in every letter from every professional as well as the

> treatment recommendations, as specific as possible, motor planing

> techniques, PROMPT usually etc.

>

> Aetna for example plays another trick, it has apraxia listed under

> conditions it does not cover because they are developmental--which of

> course is not true, So unless the exact definition is in every letter,

> stating clearly that it is a neurological disorder, they may go only

> to their exclusions list and see it there and just refuse treatment

> based on their improper categorization.

>

> I am sure other insurances play the same trick. You see when a child

> cannot produce speech and speech sounds that is a loss of body

> function that needs to be medically treated. it is NOT a developmental

> delay or an educational issue. Most schools are not equiped to treat a

> motor planning speech disorder and offer generic articulation speech

> and language therapy, often in group and this is completly

> inappropriate for an apraxic child. So if you have secured this

> diagnosis, while it's not an easy one to overcome, it is just a matter

> of being persistent enough to get insurance to cover it, because if

> taken to higher reviews they simply have to cover it, there is no way

> they can deny a loss of body function to a child when they would not

> deny it to an adult presenting with the same symptoms.

>

> And children with apraxia, as adults with this diagnosis do make

> progress and many overcome it to the point where only at times do they

> still show difficulties in speech. Other less so but the difference

> appropriate therapy makes is HUGE. So not only does it have to be

> speech therapy, but it needs to be appropriate for the disorder : 1:1

> frequent, 3-5 times a week with a skilled motor planning expert

> (PROMPT is most effective for most).

>

> This is what you MUST insist on. It is actually easier to deal with

> insurance in terms of what they are required by law to cover when a

> doctor declares it a medical necessity than to get the school district

> to provide something they are just not capable of doing and can always

> claim they are doing but in fact are not and the child can get

> inappropriate therapy, wrong type, wrong therapist, group not 1:1

> etc. So your best bet is making the insurance company realize you are

> NOT going to go away and save themselves some effort and agree to

> cover sooner. The school district battle is much much harder and you

> have less control as it can look good on paper but in actuality fail

> to meet your child needs and proving that before your child misses out

> ion the best time for intervention can sometimes be tricky to do. Keep

> at it, you'll do fine. They Have to reimburse, it is a loss of normal

> body function and they cannot discriminate against a child because of

> his age.

>

> Also progress reports from the speech therapist can show that they

> are wrong about their statement that apraxia does not improve. There

> is so much research on this that it''s not even an issue, they just

> pulled that out of their - - - to scare you off, but it clearly is NOT

> a valid statement and they know it. Just keep at it...

>

> All the best,

> Elena--mom to Ziana--almost 4 now, severely apraxic but otherwise a

> happy healthy child and making great progress now that appropriate

> speech therapy/diet and supplements have all been implemented.

>

>

> From: <hgroves@... <mailto:hgroves%40krenim.org>>

> Subject: [ ] Introduction and good website for sound

> repetition

>

> <mailto: %40>

> Date: Friday, August 15, 2008, 10:31 AM

>

> Hi,

>

> I guess it is time to introduce myself. I have been lurking for

> about a month now I guess. My son Isaac has been diagnosed with

> verbal apraxia. He is 2 3/4 years old. He goes to speech therapy

> and depending upon his mood is either very cooperative or not at

> all We pay out of pocket because our insurance declined to cover

> us stating that " Speech therapy has not been shown to be an

> effective treatment in apraxia " (!) I would love to know what they

> do consider effective. Chanting over his head with glow sticks? He

> was given the proper neuro diagnoses and everything for the

> insurance submission, so I was gobsmaked. We are appealing the

> ruling b/c it seems a no brainer that speech therapy has been proven

> effective for many speech issues including apraxia, but anyway I

> digress.

>

> I have gotten so much good info off of this group (thanks especially

> for the ProEFA tip, that has been amazing), and I wanted to share a

> website our speech therapist uses with Isaac to help him with sounds

> and such. It is www.starfall.com. It is free and is intended for

> use by elementary school and special needs teachers. We use it at

> home with him as well as part of his homework. He is an early

> reader which helps and has known his alphabet forever (just doesn't

> pronounce all the letters correctly), but maybe this will be useful

> to someone else also working on repetion of sounds.

>

> We do the " ABC " option. For this one you click on a letter in the

> alphabet screen and the upper and lowercase letters appear for the

> letter. Clicking on the upper or lowercase letters gives the proper

> sound for that letter. When the child repeats the sound correctly

> you (or the child) clicks a button that gives a reward. So for

> example, saying the " k " sound gives him the reward of a picture of a

> Kangaroo (which is also pronounced). It is good for vocabulary

> building and reading too. And it is free. And grows with the

> child. Anyway, I liked it and found it cool. The website is very

> benign but depending on treatment you may want to discuss with your

> therapist as to whether it would be useful for where your child is

> at. (Hope that last part didn't sound preachy it wasn't my intent.)

>

> Thanks again for such a great group.

>

> Groves

>

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>

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