Re:Insurance Coverage for Apraxia???

[Guest guest]

Hi,

I have been a " lurker " on this board for the past

couple of years. My daughter, aged 4, was diagnosed

with apraxia around age 2. I also have a 2.5 yr old

son who is being diagnosed with apraxia now as well.

When my daughter was first diagnosed I wrote a msg to

this board asking for help with insurance coverage. I

had great insurance they were just refusing to pay for

speech therapy, even though we were told our plan did

cover ST. Since then my hubby got a new job, and we

moved to a new state, VA, and of course have new

insurance, UHC, a PPO plan. This plan says they will

only pay if the therapy is needed for " rehabilitative

purposes " , or if my child was born with a congenital

birth defect requiring ST to speak, such as cleft

palate. I seem to remember a couple of years ago

someone sent me something like a federal law or

regulation on insurance that stated insurance

companies could not deny ST for certain reasons. I

don't remember all the particulars, but if there is

anyone out there who can help me, if that's possible,

I would truly appreciate it. I am ready to go to

battle again and I need to be armed.

Oh, when I explained to my current insurance people

that my son was diagnosed with apraxia, a

neurological, or medical illness, they said it didn't

matter...It only matters if it is considered a birth

defect or " rehabilitative " . Thanks for any help!!!

[Guest guest]

Hi and others with UHC PPO, I also have UHC of Ohio and I was told that

my plan pays for speech if the patient was injured and caused the loss of

speech. My Dr. wrote a letter stating that due to the multiple ear infections

that my dd endured thus requiring tubes it was his recommendation that speech

therapy be covered because it was due to the fact that she had sustained injury

to her inner ears from the multiple ear infections. I sent this letter about

45 days ago and I havent heard anything as of yet. I will call tomarrow and

see if they have considered this and I will let you all know. If it does work

if any of your children also sustained multiple ear infections and had to have

tube placement this may work. Keep your fingers crossed. Traci

[Guest guest]

Hi Everyone,

Like , my wife Ann and I have been mostly lurkers

on this site. We also have the UHC PPO plan here in

New York State and were told the same thing about

speech therapy for apraxia (in 's not below). If

anyone does have any legal backing to go to UHC and

say they can't deny services, we would be interested

in receiving that information as well.

Thank you,

Jim Carlone

[Guest guest]

To all those with UHC PPO's

I would say appeal, appeal, appeal!! My husband got his HR person involved

and after 2 denials it finally went through. We have a high deductable &

they paid a portion of each visit, but some is better than none!!

Tammy I. in FL mom to 5 1/2 apraxic

From: Jim and Ann Carlone <jacenterprise@...>

Reply-

Subject: Re: [ ] Re:Insurance Coverage for Apraxia???

Date: Sun, 4 Jan 2004 16:29:44 -0800 (PST)

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