Re: Insurance limit on speech therapy....

[Guest guest]

HI, I think you should appeal to the insurance co if they won't

give you more just don't take no for an answer appeal appeal. I also think that

if the IEP states one on one they have to provide it or pay for it else where.

If the IEP doesn't state it have another IEP meeting and change it, the fact

that the school doesn't have the staff isn't a concern of yours at least that

is my understanding of the law. Good luck! -Clare

[Guest guest]

Yes, I had Aetna and Guardian. Aetna limited me and I fought back for the

summer months b/c he was not in a ESY program, so therefore I had to use a

medical based therapy for speech. I appealed 2 times and had a neurologist,

speech pathologist, and OT evaluations requesting treatment was necessary due to

regression. All reports were in medical terminology not educationally based.

If your employer has a medical benefits coordinator you may want to ask for

their assistance in writing a letter requesting more therapy treatment sessions

due to your child's medical necessity.

Good luck!

Joanne Mulholland

Diane wrote:

Hi,

Has anyone had to appeal their insurance when they have a limit on

speech therapy sessions? This summer is is receiving intensive

therapy 5 days a week for 1 hour. In the school year he will receive

2-1 hour sessions and 1-30 minute sessions. He does receive speech

in school but in a group setting. At the moment there is openings

for 9 SLP's in our school district so there is no chance he would

receive individual therapy since they are so short handed.

We have Blue Cross and have a 20 session limit per year. My son has

appraxia, aphasia (codes are 784.3,784.69 & 784.5)

He has an arachnoid cyst on the left temporal lobe and " conduction

type dysphasia related to the epileptiform discharge in that

abnormal region " (as written in the report)

The feeling I got from our Human resource person was that it was

stated in the contract of 20 sessions only and she felt that I

probably wouldn't be able to get them to extend it. But coming from

her I feel that she was trying to discourage me from doing that. But

if I knew that there was a possibility then I would give it all I

have.

Thanks for any suggestions you may have.

Blessings,

Diane

Mom to Caleb 7

[Guest guest]

If your policy provides limited or no coverage for speech pathology services:

Find out if your employer offers another plan that provides coverage for

speech and language services. If so, switch to that plan during the next open

enrollment period.

Send a letter to your employer requesting better coverage in upcoming

insurance plans. Employers have the greatest influence in obtaining better

insurance coverage as they negotiate the contracts with the insurance companies.

Your company will have no idea of the need for speech therapy coverage unless

you inform them that you were denied for coverage. Group insurance coverage for

speech and language evaluations and therapy is a relatively inexpensive rider

for most companies to add to their existing policies.

Inform your employer about any limitations in your plan, especially if your

health insurance plan is self-insured by your employer. Your employer may be

able to add speech services in future plans. Your state Department of Insurance

may have limited jurisdiction over self-insured plans. With self-insured plans,

the employer provides the money, decides what benefits to offer and what claims

to pay. Theoretically, the insurance company just " follows orders. " The

regulator over self-insured plans is the US Department of Labor, Pension and

Welfare Benefits Administration at (202) 219-8776.

I found this on the apraxia-kids.org website.

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[ ] Insurance limit on speech therapy....

Hi,

Has anyone had to appeal their insurance when they have a limit on

speech therapy sessions? This summer is is receiving intensive

therapy 5 days a week for 1 hour. In the school year he will receive

2-1 hour sessions and 1-30 minute sessions. He does receive speech

in school but in a group setting. At the moment there is openings

for 9 SLP's in our school district so there is no chance he would

receive individual therapy since they are so short handed.

We have Blue Cross and have a 20 session limit per year. My son has

appraxia, aphasia (codes are 784.3,784.69 & 784.5)

He has an arachnoid cyst on the left temporal lobe and " conduction

type dysphasia related to the epileptiform discharge in that

abnormal region " (as written in the report)

The feeling I got from our Human resource person was that it was

stated in the contract of 20 sessions only and she felt that I

probably wouldn't be able to get them to extend it. But coming from

her I feel that she was trying to discourage me from doing that. But

if I knew that there was a possibility then I would give it all I

have.

Thanks for any suggestions you may have.

Blessings,

Diane

Mom to Caleb 7