Tackling the insurance company

[Guest guest]

I have a couple of questions regarding tackling our insurance

company that I am hoping that experienced parents on this list will

be able to help with. I have an almost-3-year-old who is as yet

undiagnosed but probably will be diagnosed with apraxia. He is

transitioning from Part C services of our EI (which have been

wonderful) to Part B and will be going to preschool in January.

Because of his young age the program he is going into is

called " Beginnings " and is one day a week for 90 minutes. Obviously

we feel that will not be enough ST for him and need to deal with

insurance at this point. He will be seeing a developmental

pediatrician at the end of November to help us with a letter of

medical necessity and some medical diagnosis. So, now we come to my

questions...

1. Has anyone tried to fight the calendar year maximums? Our

totally inadequate insurance through my husband's union pays for a

whopping $1000 per calendar year for speech services.

2. Has anyone been successful in getting speech through home

health? This is my little loophole I hope, our insurance WILL pay

for 100 ST visits through home health, the problem will be getting

them to agree to it.

My thanks,

Rehor

[Guest guest]

,

About 4 years ago I appealed the denial of ST services for my son and won, but I

had help from my husbands insurance benefits provider and flexible spending plan

administrator. Is it possible for you to contact your husband's employer and

request the human resource dept. in charge of health benefits to discuss this

matter with you.

It was suggested that insurance companies were tightening their therapy payments

to a limited amount a year, but there was a supplemental program I was able to

purchase due to my son's pre-existing condition. The plan came out of my

pocket, but it was a lot cheaper than paying out of pocket directly to the ST

and OT.

Good luck!

Regards,

Joanne

-------------- Original message --------------

>

>

>

> I have a couple of questions regarding tackling our insurance

> company that I am hoping that experienced parents on this list will

> be able to help with. I have an almost-3-year-old who is as yet

> undiagnosed but probably will be diagnosed with apraxia. He is

> transitioning from Part C services of our EI (which have been

> wonderful) to Part B and will be going to preschool in January.

> Because of his young age the program he is going into is

> called " Beginnings " and is one day a week for 90 minutes. Obviously

> we feel that will not be enough ST for him and need to deal with

> insurance at this point. He will be seeing a developmental

> pediatrician at the end of November to help us with a letter of

> medical necessity and some medical diagnosis. So, now we come to my

> questions...

>

> 1. Has anyone tried to fight the calendar year maximums? Our

> totally inadequate insurance through my husband's union pays for a

> whopping $1000 per calendar year for speech services.

>

> 2. Has anyone been successful in getting speech through home

> health? This is my little loophole I hope, our insurance WILL pay

> for 100 ST visits through home health, the problem will be getting

> them to agree to it.

>

> My thanks,

> Rehor

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Thanks Joann, that gives me somewhere to start. Unfortunately I

don't get to deal directly with his employer, I have to deal with

the Union. The flip side of that is that there is a board of

directors to appeal to.

My thanks,

allison

>

> ,

>

> About 4 years ago I appealed the denial of ST services for my son

and won, but I had help from my husbands insurance benefits provider

and flexible spending plan administrator. Is it possible for you to

contact your husband's employer and request the human resource dept.

in charge of health benefits to discuss this matter with you.

>

> It was suggested that insurance companies were tightening their

therapy payments to a limited amount a year, but there was a

supplemental program I was able to purchase due to my son's pre-

existing condition. The plan came out of my pocket, but it was a

lot cheaper than paying out of pocket directly to the ST and OT.

>

> Good luck!

>

> Regards,

> Joanne

[Guest guest]

,

I wish I had answers to your questions. My best advice is to get to know

your insurance policy manual like the back of you hand. It sounds like you

have already taken that approach; GOOD FOR YOU!

I just wanted to make sure you had seen this insurance help section on

speechville:

http://www.speech-express.com/diagnosis-destinations/apraxia/insurance.html

Best of luck!

Tricia Morin

North Carolina

wrote:

I have a couple of questions regarding tackling our insurance

company that I am hoping that experienced parents on this list will

be able to help with. I have an almost-3-year-old who is as yet

undiagnosed but probably will be diagnosed with apraxia. He is

transitioning from Part C services of our EI (which have been

wonderful) to Part B and will be going to preschool in January.

Because of his young age the program he is going into is

called " Beginnings " and is one day a week for 90 minutes. Obviously

we feel that will not be enough ST for him and need to deal with

insurance at this point. He will be seeing a developmental

pediatrician at the end of November to help us with a letter of

medical necessity and some medical diagnosis. So, now we come to my

questions...

1. Has anyone tried to fight the calendar year maximums? Our

totally inadequate insurance through my husband's union pays for a

whopping $1000 per calendar year for speech services.

2. Has anyone been successful in getting speech through home

health? This is my little loophole I hope, our insurance WILL pay

for 100 ST visits through home health, the problem will be getting

them to agree to it.