insurance issues

[Guest guest]

United's official policy is 20 visits of speech therapy per year if

your child had an " injury, stroke, or congenital anomaly " . When I

called the person parroted the exact terms above PLUS the

term " Autism " . This to me means their book is different from mine

and fighting it is worthwhile even when the outcome may be not what

was hoped for.

I have learned through experience that the policy's terms are

flexible if you know how to work the system.

> >

> > This pediatrician may simply be aware that this certain HMO

NEVER covers pediatric ST and OT. Not that it is not worth asking

the question, but don't shoot the messenger.

[Guest guest]

" I have learned through experience that the policy's terms are

flexible if you know how to work the system. "

I completely agree. Somehow my son's private SLP managed to get 60

visits out of united. I don't know how she did it; she's something

of a miracle worker. He does not have an official diagnosis yet,

but she did research codes online (and I know she has the Late

Talker book). She also tries to form a contact at the insurance

company when she works on a claim and follows up with that same

person each time.

> > >

> > > This pediatrician may simply be aware that this certain HMO

> NEVER covers pediatric ST and OT. Not that it is not worth asking

> the question, but don't shoot the messenger.

>

[Guest guest]

" I have learned through experience that the policy's terms are

flexible if you know how to work the system. "

I completely agree. Somehow my son's private SLP managed to get 60

visits out of united. I don't know how she did it; she's something

of a miracle worker. He does not have an official diagnosis yet,

but she did research codes online (and I know she has the Late

Talker book). She also tries to form a contact at the insurance

company when she works on a claim and follows up with that same

person each time.

> > >

> > > This pediatrician may simply be aware that this certain HMO

> NEVER covers pediatric ST and OT. Not that it is not worth asking

> the question, but don't shoot the messenger.

>

[Guest guest]

would you please find out how your SLP managed to get speech covered from

United. That is wonderful! My SLP keeps saying that the codes I am asking her

to try are unethical because they are OT codes.

myjunkytrash <myjunkytrash@...> wrote: " I have learned through

experience that the policy's terms are

flexible if you know how to work the system. "

I completely agree. Somehow my son's private SLP managed to get 60

visits out of united. I don't know how she did it; she's something

of a miracle worker. He does not have an official diagnosis yet,

but she did research codes online (and I know she has the Late

Talker book). She also tries to form a contact at the insurance

company when she works on a claim and follows up with that same

person each time.

> > >

> > > This pediatrician may simply be aware that this certain HMO

> NEVER covers pediatric ST and OT. Not that it is not worth asking

> the question, but don't shoot the messenger.

>

---------------------------------

Get your own web address for just $1.99/1st yr. We'll help. Small

Business.

[Guest guest]

would you please find out how your SLP managed to get speech covered from

United. That is wonderful! My SLP keeps saying that the codes I am asking her

to try are unethical because they are OT codes.

myjunkytrash <myjunkytrash@...> wrote: " I have learned through

experience that the policy's terms are

flexible if you know how to work the system. "

I completely agree. Somehow my son's private SLP managed to get 60

visits out of united. I don't know how she did it; she's something

of a miracle worker. He does not have an official diagnosis yet,

but she did research codes online (and I know she has the Late

Talker book). She also tries to form a contact at the insurance

company when she works on a claim and follows up with that same

person each time.

> > >

> > > This pediatrician may simply be aware that this certain HMO

> NEVER covers pediatric ST and OT. Not that it is not worth asking

> the question, but don't shoot the messenger.

>

---------------------------------

Get your own web address for just $1.99/1st yr. We'll help. Small

Business.

[Guest guest]

I will find out for sure but they might be what your SLP would

consider " OT codes. " I don't think it's unethical though because

the SLP isn't claiming to be an OT, so the insurance company knows

she is an SLP and let's face it--those insurance companies know how

to look out for themselves! Maybe you could point this out to your

SLP. She isn't breaking any rules if she isn't misrepresenting who

she is (an SLP) and the services she is providing (speech therapy)

and if your child does have issues that fall under the codes.

Apraxia requires an OT approach to speech therapy because our kids

aren't aware of their mouths and don't have full control over moving

their mouths and tongues. There might also be some SI-related

problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating

your child? If she isn't using oral-motor techniques then she might

feel uncomfortable using those codes, but more importantly, she

might not be the best fit for your child...

" I have learned

through experience that the policy's terms are

> flexible if you know how to work the system. "

>

> I completely agree. Somehow my son's private SLP managed to get 60

> visits out of united. I don't know how she did it; she's something

> of a miracle worker. He does not have an official diagnosis yet,

> but she did research codes online (and I know she has the Late

> Talker book). She also tries to form a contact at the insurance

> company when she works on a claim and follows up with that same

> person each time.

[Guest guest]

I will find out for sure but they might be what your SLP would

consider " OT codes. " I don't think it's unethical though because

the SLP isn't claiming to be an OT, so the insurance company knows

she is an SLP and let's face it--those insurance companies know how

to look out for themselves! Maybe you could point this out to your

SLP. She isn't breaking any rules if she isn't misrepresenting who

she is (an SLP) and the services she is providing (speech therapy)

and if your child does have issues that fall under the codes.

Apraxia requires an OT approach to speech therapy because our kids

aren't aware of their mouths and don't have full control over moving

their mouths and tongues. There might also be some SI-related

problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating

your child? If she isn't using oral-motor techniques then she might

feel uncomfortable using those codes, but more importantly, she

might not be the best fit for your child...

> > > >

> > > > This pediatrician may simply be aware that this certain HMO

> > NEVER covers pediatric ST and OT. Not that it is not worth

asking

> > the question, but don't shoot the messenger.

> >

>

>

>

>

>

>

> ---------------------------------

> Get your own web address for just $1.99/1st yr. We'll help.

Small Business.

>

>

[Guest guest]

I will find out for sure but they might be what your SLP would

consider " OT codes. " I don't think it's unethical though because

the SLP isn't claiming to be an OT, so the insurance company knows

she is an SLP and let's face it--those insurance companies know how

to look out for themselves! Maybe you could point this out to your

SLP. She isn't breaking any rules if she isn't misrepresenting who

she is (an SLP) and the services she is providing (speech therapy)

and if your child does have issues that fall under the codes.

Apraxia requires an OT approach to speech therapy because our kids

aren't aware of their mouths and don't have full control over moving

their mouths and tongues. There might also be some SI-related

problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating

your child? If she isn't using oral-motor techniques then she might

feel uncomfortable using those codes, but more importantly, she

might not be the best fit for your child...

" I have learned

through experience that the policy's terms are

> flexible if you know how to work the system. "

>

> I completely agree. Somehow my son's private SLP managed to get 60

> visits out of united. I don't know how she did it; she's something

> of a miracle worker. He does not have an official diagnosis yet,

> but she did research codes online (and I know she has the Late

> Talker book). She also tries to form a contact at the insurance

> company when she works on a claim and follows up with that same

> person each time.

[Guest guest]

I will find out for sure but they might be what your SLP would

consider " OT codes. " I don't think it's unethical though because

the SLP isn't claiming to be an OT, so the insurance company knows

she is an SLP and let's face it--those insurance companies know how

to look out for themselves! Maybe you could point this out to your

SLP. She isn't breaking any rules if she isn't misrepresenting who

she is (an SLP) and the services she is providing (speech therapy)

and if your child does have issues that fall under the codes.

Apraxia requires an OT approach to speech therapy because our kids

aren't aware of their mouths and don't have full control over moving

their mouths and tongues. There might also be some SI-related

problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating

your child? If she isn't using oral-motor techniques then she might

feel uncomfortable using those codes, but more importantly, she

might not be the best fit for your child...

> > > >

> > > > This pediatrician may simply be aware that this certain HMO

> > NEVER covers pediatric ST and OT. Not that it is not worth

asking

> > the question, but don't shoot the messenger.

> >

>

>

>

>

>

>

> ---------------------------------

> Get your own web address for just $1.99/1st yr. We'll help.

Small Business.

>

>

[Guest guest]

Is there a separate code for " dyspraxia " ? The doctor stated that my son was

dyspraxic, but then neglected to use the code for it.

alpy2@... wrote: The doctor is wrong about apraxic kids not being

able to speak necessarily.

The doctor is assuming that apraxia means total lack of speech (from Latin

root " a " which means " absence of " ). Technically, he's correct. Technically, a

child who can speak but not properly would be " dyspraxic. " But in the U.S.,

these terms are interchangeable (in Britain I believe they tend to make this

distinction that we Americans usually don't).

Perhaps your doctor would be more comfortable with a diagnosis of

" dyspraxia. "

Hope this helps!

Sandy, Illinois (alpy2@...)

Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA reauthorization)

[Guest guest]

Is there a separate code for " dyspraxia " ? The doctor stated that my son was

dyspraxic, but then neglected to use the code for it.

alpy2@... wrote: The doctor is wrong about apraxic kids not being

able to speak necessarily.

The doctor is assuming that apraxia means total lack of speech (from Latin

root " a " which means " absence of " ). Technically, he's correct. Technically, a

child who can speak but not properly would be " dyspraxic. " But in the U.S.,

these terms are interchangeable (in Britain I believe they tend to make this

distinction that we Americans usually don't).

Perhaps your doctor would be more comfortable with a diagnosis of

" dyspraxia. "

Hope this helps!

Sandy, Illinois (alpy2@...)

Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA reauthorization)

[Guest guest]

I know that the PT and the OT use the same code of Low muscle tone, and my

daughter's SLP uses many methods during the session that I would consider OT. A

good bit of time during her speech session is spent performing exercises to

strengthen her mouth. She is a great SLP but she just feels that using what she

considers to be an OT code is not something she will do. She just reminds me to

be careful of what I am reading from this group. Also, I don't think there are

codes designated just for speech, or OT, I assumed the codes were to describe a

diagnosis. She uses the code for verbal apraxia and the OT uses the code for

muscle tone, the OT could very well use the apraxia code because they go hand in

hand.

myjunkytrash <myjunkytrash@...> wrote: I will find out for sure

but they might be what your SLP would

consider " OT codes. " I don't think it's unethical though because

the SLP isn't claiming to be an OT, so the insurance company knows

she is an SLP and let's face it--those insurance companies know how

to look out for themselves! Maybe you could point this out to your

SLP. She isn't breaking any rules if she isn't misrepresenting who

she is (an SLP) and the services she is providing (speech therapy)

and if your child does have issues that fall under the codes.

Apraxia requires an OT approach to speech therapy because our kids

aren't aware of their mouths and don't have full control over moving

their mouths and tongues. There might also be some SI-related

problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating

your child? If she isn't using oral-motor techniques then she might

feel uncomfortable using those codes, but more importantly, she

might not be the best fit for your child...

> > > >

> > > > This pediatrician may simply be aware that this certain HMO

> > NEVER covers pediatric ST and OT. Not that it is not worth

asking

> > the question, but don't shoot the messenger.

> >

>

>

>

>

>

>

> ---------------------------------

> Get your own web address for just $1.99/1st yr. We'll help.

Small Business.

>

>

[Guest guest]

Greetings... I'm an SLP and I try to keep up with this posting because a lot of

good ideas are shared here. This posting on insurance issues intrigued me and I

thought I would reply... Basically, anyone can use those billing codes, but

typically, insurance companies have a list of acceptable billers (e.g., anyone

can bill using the low muscle tone code, but only PT and OT may get reimbursed).

Also, insurance companies tend to track codes and the people who are billing

them. If they find an SLP is using an " atypical " code, they may request an

audit (which, yes, is similar to an IRS audit). So, this is tricky business.

Personally, I tend to look up those codes I am considering (either through the

insurance companies website or on my professional website) before billing if it

is an " atypical " code. Most professions have a list of codes that are accepted

for that profession. Hope this helps!!

J.

@...: jaemegcola@...: Thu, 12

Oct 2006 06:48:54 -0700Subject: Re: [ ] Re: insurance issues

I know that the PT and the OT use the same code of Low muscle tone, and my

daughter's SLP uses many methods during the session that I would consider OT. A

good bit of time during her speech session is spent performing exercises to

strengthen her mouth. She is a great SLP but she just feels that using what she

considers to be an OT code is not something she will do. She just reminds me to

be careful of what I am reading from this group. Also, I don't think there are

codes designated just for speech, or OT, I assumed the codes were to describe a

diagnosis. She uses the code for verbal apraxia and the OT uses the code for

muscle tone, the OT could very well use the apraxia code because they go hand in

hand. myjunkytrash <myjunkytrash@...> wrote: I will find out for sure but

they might be what your SLP would consider " OT codes. " I don't think it's

unethical though because the SLP isn't claiming to be an OT, so the insurance

company knows she is an SLP and let's face it--those insurance companies know

how to look out for themselves! Maybe you could point this out to your SLP. She

isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and

the services she is providing (speech therapy) and if your child does have

issues that fall under the codes. Apraxia requires an OT approach to speech

therapy because our kids aren't aware of their mouths and don't have full

control over moving their mouths and tongues. There might also be some

SI-related problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating your child? If

she isn't using oral-motor techniques then she might feel uncomfortable using

those codes, but more importantly, she might not be the best fit for your

child...> > > > > > > > This pediatrician may simply be aware that this certain

HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > >

the question, but don't shoot the messenger. > >> > > > > > >

---------------------------------> Get your own web address for just $1.99/1st

yr. We'll help. Small Business.> > [Non-text portions of this message

have been removed]>__________________________________________________Do You

?Tired of spam? has the best spam protection around

http://mail.

[Guest guest]

The code for Apraxia is 784.69

Gordon

<momster451@...>

Sent by: cc:

@yaho Subject: Re:

[ ] Insurance issues

ogroups.com

10/11/2006 10:09 AM

Please respond to

Is there a separate code for " dyspraxia " ? The doctor stated that my son was

dyspraxic, but then neglected to use the code for it.

alpy2@... wrote: The doctor is wrong about apraxic kids not

being able to speak necessarily.

The doctor is assuming that apraxia means total lack of speech (from Latin

root " a " which means " absence of " ). Technically, he's correct. Technically,

a

child who can speak but not properly would be " dyspraxic. " But in the U.S.,

these terms are interchangeable (in Britain I believe they tend to make

this

distinction that we Americans usually don't).

Perhaps your doctor would be more comfortable with a diagnosis of

" dyspraxia. "

Hope this helps!

Sandy, Illinois (alpy2@...)

Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA

reauthorization)

[Guest guest]

I know that the PT and the OT use the same code of Low muscle tone, and my

daughter's SLP uses many methods during the session that I would consider OT. A

good bit of time during her speech session is spent performing exercises to

strengthen her mouth. She is a great SLP but she just feels that using what she

considers to be an OT code is not something she will do. She just reminds me to

be careful of what I am reading from this group. Also, I don't think there are

codes designated just for speech, or OT, I assumed the codes were to describe a

diagnosis. She uses the code for verbal apraxia and the OT uses the code for

muscle tone, the OT could very well use the apraxia code because they go hand in

hand.

myjunkytrash <myjunkytrash@...> wrote: I will find out for sure

but they might be what your SLP would

consider " OT codes. " I don't think it's unethical though because

the SLP isn't claiming to be an OT, so the insurance company knows

she is an SLP and let's face it--those insurance companies know how

to look out for themselves! Maybe you could point this out to your

SLP. She isn't breaking any rules if she isn't misrepresenting who

she is (an SLP) and the services she is providing (speech therapy)

and if your child does have issues that fall under the codes.

Apraxia requires an OT approach to speech therapy because our kids

aren't aware of their mouths and don't have full control over moving

their mouths and tongues. There might also be some SI-related

problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating

your child? If she isn't using oral-motor techniques then she might

feel uncomfortable using those codes, but more importantly, she

might not be the best fit for your child...

> > > >

> > > > This pediatrician may simply be aware that this certain HMO

> > NEVER covers pediatric ST and OT. Not that it is not worth

asking

> > the question, but don't shoot the messenger.

> >

>

>

>

>

>

>

> ---------------------------------

> Get your own web address for just $1.99/1st yr. We'll help.

Small Business.

>

>

[Guest guest]

Greetings... I'm an SLP and I try to keep up with this posting because a lot of

good ideas are shared here. This posting on insurance issues intrigued me and I

thought I would reply... Basically, anyone can use those billing codes, but

typically, insurance companies have a list of acceptable billers (e.g., anyone

can bill using the low muscle tone code, but only PT and OT may get reimbursed).

Also, insurance companies tend to track codes and the people who are billing

them. If they find an SLP is using an " atypical " code, they may request an

audit (which, yes, is similar to an IRS audit). So, this is tricky business.

Personally, I tend to look up those codes I am considering (either through the

insurance companies website or on my professional website) before billing if it

is an " atypical " code. Most professions have a list of codes that are accepted

for that profession. Hope this helps!!

J.

@...: jaemegcola@...: Thu, 12

Oct 2006 06:48:54 -0700Subject: Re: [ ] Re: insurance issues

I know that the PT and the OT use the same code of Low muscle tone, and my

daughter's SLP uses many methods during the session that I would consider OT. A

good bit of time during her speech session is spent performing exercises to

strengthen her mouth. She is a great SLP but she just feels that using what she

considers to be an OT code is not something she will do. She just reminds me to

be careful of what I am reading from this group. Also, I don't think there are

codes designated just for speech, or OT, I assumed the codes were to describe a

diagnosis. She uses the code for verbal apraxia and the OT uses the code for

muscle tone, the OT could very well use the apraxia code because they go hand in

hand. myjunkytrash <myjunkytrash@...> wrote: I will find out for sure but

they might be what your SLP would consider " OT codes. " I don't think it's

unethical though because the SLP isn't claiming to be an OT, so the insurance

company knows she is an SLP and let's face it--those insurance companies know

how to look out for themselves! Maybe you could point this out to your SLP. She

isn't breaking any rules if she isn't misrepresenting who she is (an SLP) and

the services she is providing (speech therapy) and if your child does have

issues that fall under the codes. Apraxia requires an OT approach to speech

therapy because our kids aren't aware of their mouths and don't have full

control over moving their mouths and tongues. There might also be some

SI-related problems or low tone issues too--all of which can affect speech.

There really is a big overlap, I think. How is your SLP treating your child? If

she isn't using oral-motor techniques then she might feel uncomfortable using

those codes, but more importantly, she might not be the best fit for your

child...> > > > > > > > This pediatrician may simply be aware that this certain

HMO > > NEVER covers pediatric ST and OT. Not that it is not worth asking > >

the question, but don't shoot the messenger. > >> > > > > > >

---------------------------------> Get your own web address for just $1.99/1st

yr. We'll help. Small Business.> > [Non-text portions of this message

have been removed]>__________________________________________________Do You

?Tired of spam? has the best spam protection around

http://mail.

[Guest guest]

The code for Apraxia is 784.69

Gordon

<momster451@...>

Sent by: cc:

@yaho Subject: Re:

[ ] Insurance issues

ogroups.com

10/11/2006 10:09 AM

Please respond to

Is there a separate code for " dyspraxia " ? The doctor stated that my son was

dyspraxic, but then neglected to use the code for it.

alpy2@... wrote: The doctor is wrong about apraxic kids not

being able to speak necessarily.

The doctor is assuming that apraxia means total lack of speech (from Latin

root " a " which means " absence of " ). Technically, he's correct. Technically,

a

child who can speak but not properly would be " dyspraxic. " But in the U.S.,

these terms are interchangeable (in Britain I believe they tend to make

this

distinction that we Americans usually don't).

Perhaps your doctor would be more comfortable with a diagnosis of

" dyspraxia. "

Hope this helps!

Sandy, Illinois (alpy2@...)

Volunteer Co-Webmaster, www.ourchildrenleftbehind.com (IDEA

reauthorization)

[Guest guest]

The neurologist used 783.40 and 758.9. I have to ask what our OT is

using; United calls it " medical services " and doesn't use a code on my

explanantion of benefits forms they send me in the mail.

[Guest guest]

The neurologist used 783.40 and 758.9. I have to ask what our OT is

using; United calls it " medical services " and doesn't use a code on my

explanantion of benefits forms they send me in the mail.

[Guest guest]

mariapepple@...

insurance issues

Sorry to take so long to respond, but I would like to know if anyone has

helpful strategies for getting insurance companies to pay for speech therapy.

So many say they will only pay for restorative speech

[Guest guest]

Has anyone had success in getting their insurance to cover Dr. G as

an " in-network provider " ? We have Anthem Blue Cross.

Thank you,

[Guest guest]

Have you gone online and checked your provider directory? We don't have Anthem

but we have Blue Cross/Blue Shield Federal Plan. From what I understand from

(you should probably call the office to confirm), if the billing goes

through Blue Shield, it's accepted.

HTH,

Robyn

> From: <ljburns83@...>

> Subject: insurance issues

>

> Date: Friday, September 19, 2008, 11:05 PM

> Has anyone had success in getting their insurance to cover

> Dr. G as

> an " in-network provider " ? We have Anthem Blue

> Cross.

>

> Thank you,

>

[Guest guest]

He doesn't take Blue Cross so you aren't likely going to be able to

get him paid as in network. You might try the autism-insurance list,

though. i think someone else tried to do it once by telling them

he's the only person that was able to help their child. I don't know

what became of it.

Cheryl

On Sep 20, 2008, at 7:23 AM, Robyn & Greg Coggins wrote:

> Have you gone online and checked your provider directory? We don't

> have Anthem but we have Blue Cross/Blue Shield Federal Plan. From

> what I understand from (you should probably call the

> office to confirm), if the billing goes through Blue Shield, it's

> accepted.

>

> HTH,

>

> Robyn

>

>

>

>

>> From: <ljburns83@...>

>> Subject: insurance issues

>>

>> Date: Friday, September 19, 2008, 11:05 PM

>> Has anyone had success in getting their insurance to cover

>> Dr. G as

>> an " in-network provider " ? We have Anthem Blue

>> Cross.

>>

>> Thank you,

>>

>

> ------------------------------------

>

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>