Insurance

[Guest guest]

Hi Kim,

I have the same insurance as you (In Michigan though)

and they won't cover even one speech therapy

appointment. They are trying to turn him down

completely. However, I am in the process of having

the doctor change the diagnosis code on the billing to

something other than the 300's. There is supposed to

be a secondary insurance in Michigan called Kid-Care

but no one bothered to tell me about it until I

started receiving some bills already.

Kim,

Mom to JJ - god only knows what.

--- kim.gill@... wrote:

> Charlotte: I can definitely respond to this one!

> I, too, have Blue

> Cross/Blue Shield - PPO and they cover only 25

> visits per year, and only

> 80% of those 25 visits. So, if my son goes to

> speech therapy 2x a week,

> then we are all done within 3 months! Oh and by

> the way, these 25 visits

> also includes OT therapy. We will be done with our

> therapy coverage in 2

> months now.

>

> But, I also know that BC/BS does not cover more for

> a developmental delay,

> but needs a medical reason....so I will be in the

> process of obtaining

> that paperwork.....and I will let you know what I

> come across.

>

> I have to tell you a funny story (not too funny).

> While I was in the

> waiting room during my son's therapy, the

> receptionist is quite an expert

> on insurance and has successfully appealled almost

> ALL of BC/BS claims.

> And I guess the president (?) of Chicago's BC/BS is

> also an owner of the

> Chicago Bears football team (which isn't doing so

> well!). She actually

> had a parent make a video of her son trying to ask

> for something.......to

> show how he can't ask for his basic needs and how

> they desperately needed

> this therapy. They then sent this in to the

> president to show him what

> they denied......and they finally did approve their

> therapy.

>

> Good luck, and let's keep eachother posted....Kim

>

>

[Guest guest]

Hi,

In terms of insurance, we have been extremly lucky. My son ph is 8 years

old & is diagnosed with Cerebral Palsy. He receives PT/OT/ST ever since he

was about 1 year old. He receives about 8 sessions per week, which is quite

a bit. We have had Humana HMO throughout the entire time and have never

dealt with the yearly visit restrictions other insurance companies impose. I

don't know if Humana exists all over the country. I am in Florida and

ph's pediatrician's insurance dept knows what codes and documentation is

needed in order to get the approvals from the insurance company every three

months which is what is required on the referrals. However due to the rising

costs of health insurance every year and the ever growing restrictions on

medical coverage, I'm nervous that they wil begin restricting the coverage

on therapies. The insurance company hasn't mentioned anything... just call

it a gut instinct. Anyway , I started to apply for the medicaid waiver

program through the Florida dept of Family and Children's. This would give

ph access to medicaid and other services (such as therapy) due to the

disability as a Family of One. This is granted based on the disability and

REGARDLESS OF FAMILY INCOME. There is a huge waiting list for state funding.

So once you apply , which we just did this October, I was told it may take

up to 2 years to get into the program. I have contacted my state

congressional representative to put some pressure. Amazingly enough I got a

telephone call from him the same day I sent in an e-mail. I was pretty

impressed. Anyway he asked for some info and the name of our case worker to

look into this matter. I'm waiting for a response... I'm holding my breath.

I'll keep everyone posted Maybe there is ia similar program in your state.

Rgds/

[Guest guest]

Thanks so much for all the words of encouragment!

I will sure keep everyone posted. I just had our first teacher's conference

today with 's teacher, and she said that he does try to participate in

class and has used some words with other children. Until he is back in therapy,

we'll keep doing what we've been taught to help him.

Thanks again! Charlotte

Re: [ ] Re: Insurance

Charlotte: I can definitely respond to this one! I, too, have Blue

Cross/Blue Shield - PPO and they cover only 25 visits per year, and only

80% of those 25 visits. So, if my son goes to speech therapy 2x a week,

then we are all done within 3 months! Oh and by the way, these 25 visits

also includes OT therapy. We will be done with our therapy coverage in 2

months now.

But, I also know that BC/BS does not cover more for a developmental delay,

but needs a medical reason....so I will be in the process of obtaining

that paperwork.....and I will let you know what I come across.

I have to tell you a funny story (not too funny). While I was in the

waiting room during my son's therapy, the receptionist is quite an expert

on insurance and has successfully appealled almost ALL of BC/BS claims.

And I guess the president (?) of Chicago's BC/BS is also an owner of the

Chicago Bears football team (which isn't doing so well!). She actually

had a parent make a video of her son trying to ask for something.......to

show how he can't ask for his basic needs and how they desperately needed

this therapy. They then sent this in to the president to show him what

they denied......and they finally did approve their therapy.

Good luck, and let's keep eachother posted....Kim

[Guest guest]

Thanks for your info. Do you know what would qualify to them as a " disability " ?

Would dx such as apraxia, sensory integration disorder, etc. qualify? Who would

I contact for more info, the FL Dept of Family and Children's?

Thanks,

Debbie

----- Original Message -----

[Guest guest]

hi you can go to http://www.ssa.gov and look under disability

,click in that category, then it has a lot of

questions and topics that are covered under the

disabled child. i hope this helps a little. stacey

--- DEBBIE COPPLE <kdcop@...> wrote:

> Thanks for your info. Do you know what would

> qualify to them as a " disability " ? Would dx such as

> apraxia, sensory integration disorder, etc. qualify?

> Who would I contact for more info, the FL Dept of

> Family and Children's?

>

> Thanks,

> Debbie

[Guest guest]

Hi Debbie,

I'm not exactly certain which diagnosis are accepted. If you are in Florida

I would definitely contact the local branch of Florida dept of family and

children's and inquire as the medicaid waiver program. You might mention

wanting to apply for your child as a family of one. Good luck and if you

have any other questions just ask.

Rgds/

[Guest guest]

Dear ,

I am also in florida and getting ready to start all that Medwaiver stuff.

is turning three in January. Please let me know which legislature you

talked to because I know I am about to embark on a very big battle to get him

the therapy he needs. Where in florida are you? We are in Parkland (close

to Ft. Lauderdale.)

Sincerely,

Heidi, mommy of

[Guest guest]

Click here: ABC for Health if you are in wisconsin

Click here: The DRM Regional Resource Directory: State Index

Click here: : Plagiocephaly Files

Click here: Insurance Issues

Click here: NICHCY State Resource Sheets

Click here: State Insurance Departments

Click here: : Plagiocephaly Files

Click here: Plagiocephaly Publications

Click here: Patient Advocate Foundation Welcomes You!

Click here: Plagiocephaly Information Center - Cranial Technologies, Inc.

Click here: Other online resources

Click here: ACF - Contacts

Click here: Insure Kids Now! A national initiative to linking families to low-cost insurance programs

Click here: newanncmntslice

these links might help.

beck

[Guest guest]

Hi kristalee0225,

Who is your insurance? Don't tell me...Cigna, right? How many appeals have you submitted? Did you have an external review? I did all this and thought I was sol, but then I found out that I had one more appeal through the employee benefits committee at my husbands employer. Do you know if you have that? Where are you located? I have the name of an attorney in Dallas who has taken many helmet reimbursement cases and has been very successful. We are planning to use him if our last appeal does not work, and I would be happy to give you his name, number and email if you would like. He said that simply writing a letter (from an attorney) usually gets the insurance company to write a check because it's cheaper than having to start paying their own lawyers just to fight over a stinkin' helmet that they should have paid for in the first place. We paid for 2 DOC bands out of pocket, so I know how you feel. Keep fighting. I think we can all win eventually, and wouldn't it be nice to get reimbursed in time for Christmas!

Gail, Sam and Sara's mom, DOC grads

Insurance

Can someone please help me on getting this covered by Insurance. Any pointers would help, Im at the end of my rope and I want to make sure I've covered everything.My son is 8 months and has been wearing his helmet for 4 weeks, it cost me 2200.00 out of pocket and I have exhaused all my levels of appeal.....Help!!ThanksFor more plagio info

[Guest guest]

Please forgive me if you have posted your story and I just can't

remember, but would you please give us a brief overview of what

has been going on? What insurance co do you have? Where are

you located? What type of helmet? What was the reason for

denial?

Check out our files section. We have some " insurance help "

information there. If you have been through all appeals levels

then you are probably ready for the external review board. Check

your policy for information about this or call the customer service

line and ask for information. You can also file a complaint

against your insurance co with your State Department of

Insurance or possibly your State Department of Health if you

have an HMO.

If you could give more details that would be appreciated. I'm

sorry that you have run into a dead end. It is really shameful that

these insurance companies pull this type of garbage.

Marci (Mom to )

Oklahoma

--- In Plagiocephaly@y..., " kristalee0225 " <kbienkowski@e...>

wrote:

> Can someone please help me on getting this covered by

Insurance. Any

> pointers would help, Im at the end of my rope and I want to

make sure

> I've covered everything.

> My son is 8 months and has been wearing his helmet for 4

weeks, it

> cost me 2200.00 out of pocket and I have exhaused all my

levels of

> appeal.....Help!!

>

> Thanks

[Guest guest]

HI & welcome to our group:

Would you please give us a few more details about your insurance

denial? Who is your carrier, why did they deny coverage, etc?

What type of helmet is your son wearing? Where abouts are you

located?

Check out the links Beck & Marci gave you, there's a ton of info that

can help you on those sites, including our group.

Maybe we have a member who also has your same insurance that could

give you some tips.

Welcome again, good luck!

Debbie Abby's mom DOCGrad

MI

>

> > Can someone please help me on getting this covered by

> Insurance. Any

> > pointers would help, Im at the end of my rope and I want to

> make sure

> > I've covered everything.

> > My son is 8 months and has been wearing his helmet for 4

> weeks, it

> > cost me 2200.00 out of pocket and I have exhaused all my

> levels of

> > appeal.....Help!!

> >

> > Thanks

[Guest guest]

Hi Charlottte

You said that your son is covered by blue cross? are you in NJ???? If

so I am curious how you managed the first 25 visits??? Our son is also

covered by blue cross of nj and they have denied all coverege of his st

for his apraxia. any help would be greatly appreciated.

thanks

Keri

Charlotte Klimchock wrote:

>I am currently battling this out too! We are under Blue Cross, and my son (has

apraxia) has used all the sessions he is allowed for the year..which is 25

visits. When our therapist sent in the notes, re -eval and so forth, requesting

an additional 25 visits..it was denied. We are now in the process of

appealing-and all therapy visits have ceased until appeal is approved.

>

>My heart just sinks...my son needs this so much. I understand that the

insurance companies have to be cautious in making these kind of

decisions...but.............oh well.

>

>charlotte

> ----- Original Message -----

>

>I am in the process of trying to get more speech therapy covered for my son.

We have Aetna US Healthcare. I've had some luck in getting more than 60 days

covered, but they said payment was made in error (?). My plan does not have a

lifetime max, but does have the 60 consecutive day coverage. The last letter

that I had written, explained that Apraxia is an illness (I quoted ASHA) and

should be treated like one, meaning that speech therapy is a medical necessity.

I haven't heard anything, yet. Feel free to contact me privately.

>

> Ilene, NJ

[Guest guest]

Hi Charlotte,

I am also wondering how you managed the first 25

visits? We are in Michigan covered under Blue Cross,

and they wouldn't even cover the eval. until JJ

reaches the age of six. We had to eat the cost of

that.

Kim

> >I am currently battling this out too! We are under

> Blue Cross, and my son (has apraxia) has used all

> the sessions he is allowed for the year..which is 25

> visits. When our therapist sent in the notes, re

> -eval and so forth, requesting an additional 25

> visits..it was denied. We are now in the process of

> appealing-and all therapy visits have ceased until

> appeal is approved.

> >

> >My heart just sinks...my son needs this so much. I

> understand that the insurance companies have to be

> cautious in making these kind of

> decisions...but.............oh well.

> >

> >charlotte

[Guest guest]

I also have the same problem with our insurance. They just won't pay for

speech or occupational therapy even when we give them the procedural codes

and the pediatrician's recommendations. It is a real injustice, but they

just want to protect the company's money, the company being the employer of

my husband. The company uses Aetna only for administrative purposes and

Aetna is great at denying almost every claim you ever send to them. I

think they are disgusting, but basically, it is the employer who wants them

to do the dirty work for them.

Rose

At 09:59 AM 3/16/2003 -0600, you wrote:

>Hello,

>

>I have a question regarding speech therapy and insurance, My son has been

>receiving speech therapy ,the insurance said they need a letter of medical

>necessity and after our Dr. sent it (DX :AUTISM} they paid for a few but

>now they say they won't pay for it anymore, I think it is because of the

>diagnosis has anyone else got their insurance to pay for speech, can we

>get it under a different diagnostic or procedure code, MY son was doing

>good with it they helped him slow down his speech his articulation was

>getting better and I could see it helped his ABA program at home. Any help

>is greatly appreciated. THANKS.Get more from the Web. FREE MSN Explorer

>download : http://explorer.msn.com

>

>

>

[Guest guest]

Hi,

Every time I get an authorization for services for my son I receive a slip

of paper from the doctors' office to give to the person who will be

providing services (no matter what type of service this is, i.e.,

neurologist, speech therapy, etc...). This slip has a diagnosis related to

this type of service (example: neurologist dx would be listed as autism,

PDD, encephalopathy, etc..., speech service dx could be speech delay or

other dx of which I am not aware...your doctors' office should be able to

help you out). I have gone to second level appeal for these services and we

are now granted 90 CONSECUTIVE days per year (Not necessarily 90 days per

year). When the doctor writes the order, the office staff calls the

insurance company for authorization for those services and the insurance

company gives the ok or requests more information. If they do request more

information, it is important that the diagnosis for speech services is NOT

related to autism and to NOT state that your son has autism at all. Many of

the departments within an insurance company do not share information, so you

may be able to get it cleared if you just try again with a different

diagnosis (be sure to not mention autism). Good luck!

Best regards,

Tamara

[Guest guest]

Hello,

I have a question regarding speech therapy and insurance, My son has been

receiving speech therapy ,the insurance said they need a letter of medical

necessity and after our Dr. sent it (DX :AUTISM} they paid for a few but now

they say they won't pay for it anymore, I think it is because of the diagnosis

has anyone else got their insurance to pay for speech, can we get it under a

different diagnostic or procedure code, MY son was doing good with it they

helped him slow down his speech his articulation was getting better and I could

see it helped his ABA program at home. Any help is greatly appreciated.

THANKS.Get more from the Web. FREE MSN Explorer download :

http://explorer.msn.com

[Guest guest]

, there is some wonderful info. on getting the insurance

companies to pay in the Late Talker Book, includes sample letters to

send as well. Others on the board can help you also.

Has Early Intervention mentioned transitioning into the public school

system to receive services? My daughter was in EI, then when she

turned 3, she started receiving speech therapy from an SLP with the

school system. (My DD is in a private preschool, and the SLP comes

there to meet with her before her class begins). It is my

understanding (I'm new to this, so others on the board can explain

better), that under federal law, you are entitled to services

provided by the school. Ask your EI coordinator about this - they

should contact the school and arrange the necessary evaluations for

you, or at least put you in contact with the right person.

Hope this helps a little! I know there are others with more

experience than me that can explain!!

Tricia

[Guest guest]

,Madison goes to a private preschool at a local church in our

town. It's actually called an Early Learning Center, they do infants

through preK.

The SLP comes there 2x/week, 30 min. sessions. They meet before

Madison goes into class. I know the SLP goes around to several

different preschools,and also the Montessori school, but I don't know

about daycares. They have never said anything about me needing to

bring her to a particular place. Not sure if it's just them " being

nice " by coming there, or if there is some rule that they have to. I

imagine if she were not in the preschool, I would have to take her

somewhere, I doubt they would come to my house!

Anyway, guess I'm not much help there! I don't think I would be

comfortable with Maddy being transported somewhere either!Maybe ask

them if they can come to the daycare center.

Tricia

[Guest guest]

Tricia, what state do u live in?

[Guest guest]

While SLP's are qualified to diagnose apraxia (ASHA itself says this),

sometimes insurance companies respond better to letters from doctors, esp.

pediatric

neurologists. Just my impression.

Also, the local school district is obligated to provide services under

federal law (IDEA) if the child qualifies. Coverage by the school begins at age

3.

EI should be experienced in this transition and should be able to help you.

We've successfully used insurance code 784.69. Avoid 315 codes - they signal

" developmental " and are a red flag to insurance companies (which usually

exclude developmental conditions and only cover medical necessity). Don't have

any evaluator use the term " developmental " in your reports - call it Childhood

Apraxia of Speech or something like that.

That's all the tidbits I can think of for now! Hope they're helpful!

Sandy, Illinois (alpy2@...)

Volunteer Co-Webmaster, <A

HREF= " www.ourchildrenleftbehind.com " >www.ourchildrenleftbehind.com</A> (IDEA

reauthorization)

[Guest guest]

I know a mom in Texas that had Medicaid and they paid 100% for the

band at CT. Her baby just graduated the Tuesday before

Thanksgiving. Good Luck. Let us know what you find out.

Dustie

--- In Plagiocephaly , " cyrellej " <cyrellej@y...>

wrote:

> Can anyone tell me if Cranial Technologies accepts medicaid

insurance?

[Guest guest]

HI Carin,

A lot also has to do with which plan your employer chose through

BCBS. I have attached a link that shows what criteria BCBS PPO of

Alabama used to pay for 2 DOCbands for my son. I think that the

most important part for us was a great letter of necessity from our

neurosurgeon, I wish I had a copy of it. I hope this link helps,

Natasha

http://www.bcbsal.com/providers/final_lmrp/008.pdf

> I am new here, and stumbled upon this site in looking for

insurance

> info. I have checked the insurance info listed here, but have a

> question for all of you. My insurance (BC/BS of ILL PPO) is

denying

> coverage for my son's helmet. I see several comapnies have paid

for

> the helmets and was wondering if anyone could get me specific

> information on their coverage that allowed payment. First I was

told

> it was experimental, then denied for cosmetic...blah blah blah I

am

> sure you are all very familiar with my story. I also see where

the

> HMO in ILL covered the treatment with no appeal.....I would love

to

> here about that one!! If it is reasonable under the HMO how can

they

> say otherwise with the PPO coverage????

> ANyway if anyone has specific information on the insurance I would

be

> very interested in reviewing it.....If companies are paying for

> treatment I want to know what they used to determine it was needed

> treatment and use that in referance with my insurance to

holefully

> get them to reverse their denial of coverage.

> Thank you

> Carin

[Guest guest]

Kim,

My husband just called his Human Resource person at the office and explained

the situation with our son and she said as long as we have a prescription from

a pediatric neurologist that they would cover it 100. You could try that.

Teri - 's mom

[Guest guest]

Hi ,

Welcome to the group. I think your best bet would be to call your local

medicaid office and ask them. I'm sure it differs from state to state.

Please let us know how you make out.

--- In Plagiocephaly , " " <b_mcdowell02@y...>

wrote:

>

> I was just wondering if state insurance (medicaid) would pay for any

> of the helmet?

[Guest guest]

Hi ,

Welcome to the group. I think your best bet would be to call your local

medicaid office and ask them. I'm sure it differs from state to state.

Please let us know how you make out.

--- In Plagiocephaly , " " <b_mcdowell02@y...>

wrote:

>

> I was just wondering if state insurance (medicaid) would pay for any

> of the helmet?