apraxia & insurance denial

[Guest guest]

Hi Everyone,

My name is Dee and I am new to the group. My 4th child was

just diagnosed with apraxia a couple of weeks ago. He is 4 years

old and has a rare syndrome called 49,XY. Even with all of this he

is still speaking and doing fairly well. He leaves out a lot of

connecting words and was found to have problems with his motor

planning.

Anyway, my question for the group is this. Have any of you had

problems with the insurance denying stating that it is a learning

disability (our insurance will not pay if it is a learning

disability)?

Thanks,

Dee

[Guest guest]

Hi Dee,

Yes - excluding speech therapy or other rehabilitative services (physical

therapy, etc.) is very common on insurance policies. The insurer's

rationale is that Early Start (state or federal govt.) programs will provide

these services for children age birth to 3, and the school district will

provide these services for children age 3 and up.

Is currently receiving any services through your local school district?

If not, you should contact the district office and find out how to request

an assessment. Since he has issues with motor planning you might request an

occupational therapy assessment as well. It is best to send requests in

writing so you have proof of when you sent it, etc. There is a great deal

of information on the web about IDEA (Individuals with Disabilities

Education Act).

Hope this helps,

Vicki

_____

From: Randy Meyers [mailto:luthercal@...]

Sent: Tuesday, August 10, 2004 5:50 AM

Subject: [ ] apraxia & insurance denial

Hi Everyone,

My name is Dee and I am new to the group. My 4th child was

just diagnosed with apraxia a couple of weeks ago. He is 4 years

old and has a rare syndrome called 49,XY. Even with all of this he

is still speaking and doing fairly well. He leaves out a lot of

connecting words and was found to have problems with his motor

planning.

Anyway, my question for the group is this. Have any of you had

problems with the insurance denying stating that it is a learning

disability (our insurance will not pay if it is a learning

disability)?

Thanks,

Dee

[Guest guest]

<<<<My name is Dee and I am new to the group. My 4th child was

just diagnosed with apraxia a couple of weeks ago. He is 4 years

old and has a rare syndrome called 49,XY. Even with all of this he

is still speaking and doing fairly well. He leaves out a lot of

connecting words and was found to have problems with his motor

planning.

Anyway, my question for the group is this. Have any of you had

problems with the insurance denying stating that it is a learning

disability (our insurance will not pay if it is a learning

disability)?>>>>>

Yes, my son is 3 1/2 and dx with apraxia by a dev. ped. Our insurance (The

Claims Trust) denied coverage on grounds that " ...speech therapy for verbal

apraxia is not covered unless due to a specific disease or brain injury. If you

can provide medical documentation showing that the apraxia is a result of a

specific disease or brain injury, then our office will be more than happy to

send this medical information off to our review board for reconsideration. "

Plan B for us is either trying to force our school district to give our son

services or possibly getting medicaid as a secondary insurance to cover private

speech therapy.

Jeanne, mom to , verbal apraxia

[Guest guest]

Jeanne--

Apraxia IS a neurological disorder. It doesn't have to be the

*result* of anything--it is a stand-alone neurologically based

disorder. You should file an appeal.

> <<<<My name is Dee and I am new to the group. My 4th child

was

> just diagnosed with apraxia a couple of weeks ago. He is 4 years

> old and has a rare syndrome called 49,XY. Even with all of this he

> is still speaking and doing fairly well. He leaves out a lot of

> connecting words and was found to have problems with his motor

> planning.

>

> Anyway, my question for the group is this. Have any of you had

> problems with the insurance denying stating that it is a learning

> disability (our insurance will not pay if it is a learning

> disability)?>>>>>

>

> Yes, my son is 3 1/2 and dx with apraxia by a dev. ped. Our

insurance (The Claims Trust) denied coverage on grounds

that " ...speech therapy for verbal apraxia is not covered unless due

to a specific disease or brain injury. If you can provide medical

documentation showing that the apraxia is a result of a specific

disease or brain injury, then our office will be more than happy to

send this medical information off to our review board for

reconsideration. "

>

> Plan B for us is either trying to force our school district to give

our son services or possibly getting medicaid as a secondary

insurance to cover private speech therapy.

>

> Jeanne, mom to , verbal apraxia