Re: I have a question of you all

[Guest guest]

Speech at public school once a month same for OT. Insurance paid for a few hours of both but only for a few months. Insurance paid 0 for ABA and RPM. Schools did 40 minutes of ABA a day after I fought for years.( recommendation from several doctors was FORTY HOURS AWEEK) I stopped counting how much it cost out of pocket. Autism is nothing compared to the FIGHT for appropriate services, supports and help from insurance which is nearly non existent.Sent from my iPhone

I have a question for all of you. How often does you insurance or your school pay for the therapies that you do for your kids? Seems to me that many of the therapies may have to be paid with cash or out of your pocket. And doctors how are you paying them? How costly is all of this for you? And, for those of you who have experience with therapies and doctors elsewhere...do you think Texas costs you more out of pocket than where you came from? Just wondering. Martha

[Guest guest]

Because our school district insurance (my husband is a teacher & I was too

before staying home with ) wouldn't cover any therapies for autism or any

developmental delay, and because we made little money for our family of five, we

had zero cost share with ECI.

Since was diagnosed before age 2, that did come in handy. By the time he

was 2 1/2, ECI was providing 17 1/2 hours a week of in home therapy....an hour

of O/T, and hour of P/T, speech, and 13 1/2 hours of ABA per week, all for free.

Knowing what the program was obligated to do helped, and having someone on THIS

board mention that Houston's ECI offered ABA helped a ton.

Once turned 3 and we lost ECI, I had to figure out a way to get

some/most of those therapies paid for. He qualified for SSI, so traditional

Medicaid picked up the P/T, O/T and Speech, and we paid for our ABA program out

of pocket. That was the hardest part, simply because it can be by far the most

expensive program.

Two and a half years into our journey, and in many ways worse off than we were

when he first regressed ( has had serial regression issues, and is still

non verbal), we now have autism coverage with our private insurance.

Unfortunately, none of the specialists who we've been referred to will take

insurance, so we're not actually much better off. Our out of network deductibles

and out of pocket maximums will probably cost us 7-10 thousand dollars, and then

they still won't pay 100%. We probably had $15,000 out of pocket in the past 12

months (since we lost ECI) for ABA and gas to trek everywhere. We'll probably

have half that out of pocket in the next 3 months just to meet the out of pocket

expenses. Hard to say at this point whether or not we'll be any better off

monetarily in the end, but at least we have a much better choice of providers.

Serena

>

> I have a question for all of you. How often does you insurance or your school

pay for the therapies that you do for your kids? Seems to me that many of the

therapies may have to be paid with cash or out of your pocket. And doctors how

are you paying them? How costly is all of this for you? And, for those of you

who have experience with therapies and doctors elsewhere..do you think Texas

costs you more out of pocket than where you came from? Just wondering. Martha

>

[Guest guest]

It really depends on your insurance company and what the company you work for has opted into.  We just moved from UT where there are no laws regarding autism, and our insurance company didn't pay a dime for anything.  In fact, we had to take my son's autism diagnosis off of all medical paperwork because the insurance company started denying anything that was for him-ear tubes, annual check ups, everything was a fight.  It was ridiculous.  We are so happy to be here in Texas where we only pay a $20 co-pay for my son's OT appointments and behavioral therapist.  But every insurance plan will be different.  We learned that while interviewing for jobs here and perusing different companies' policies.

 

I have a question for all of you.  How often does you insurance or your school pay for the therapies that you do for your kids?  Seems to me that many of the therapies may have to be paid with cash or out of your pocket. And doctors how are you paying them?  How costly is all of this for you?  And, for those of you who have experience with therapies and doctors elsewhere...do you think Texas costs you more out of pocket than where you came from?  Just wondering.  Martha

-- Houston, Cypress, and Katy Photographer. http://bethvphotography.blogspot.comBuy handmade! http://loveseptember.etsy.com

[Guest guest]

The amount of therapy provided in the public school alone is rarely enough to effect adequate progress, IMO.  We always had to supplement out of pocket  for extra therapy.  Once our son was accepted into the MDCP program, then he received a Medicaid waiver and Medicaid has been paying for his speech, OT, and PT.  Since he has been able to get an adequate amount of these therapies (an hour a week of each) we have seen some real progress, but now with budget cuts, we still wait to see what is going to be cut.  We can no longer afford to pay out of pocket, and insurance won't cover it.

We never could get any ABA covered, so I bought the manual when he was young.  We designed our own program that was a mix of ABA and Floor-time and it helped him a lot.

[Guest guest]

We have been very fortunate that our insurance has covered OT, speech and most

medical visits (billed after paying cash). However, we have not had ANY ABA

covered, even under the TX law. It is unfortunate that they would not cover the

most expensive part of our son's treatment, but we are glad for the rest. We

moved to TX from CO where we could get insurance coverage, but we could not find

the therapies, readily, that we wanted for our son. I think, no matter where

you are, that autism costs the families dearly, in money, time, energy, health

and quality of life.

Ann K

>

> I have a question for all of you. How often does you insurance or your school

pay for the therapies that you do for your kids? Seems to me that many of the

therapies may have to be paid with cash or out of your pocket. And doctors how

are you paying them? How costly is all of this for you? And, for those of you

who have experience with therapies and doctors elsewhere..do you think Texas

costs you more out of pocket than where you came from? Just wondering. Martha

>