Guest guest Posted March 21, 2007 Report Share Posted March 21, 2007 Have you contacted your congressman to see if there is an insurance ombudsman? This is definitely discrimination and apraxia should definitely be covered. I spent years fighting for what my children are entitled to receive and will continue fighting. I find that everyone denies everything until they get tired of hearing from people high up. At that point something is done. I have made some " high up " phone calls and have succeeded. They defintiely don't make it easy for us parents. 8 apraxia, SID, DCD, Hypotonia (resolved) 6 apraxia, SID, DCD, Hypotonia, (resolved) feeding 14 month apraxia, SID, Hypotonia, feeding > > Hello all!! > > Anyone who has any info on how to get Aetna to pay for speech > therapy and which codes to use I would be greatful. Therapy costs > really add up and they have an exclusion in their policy to verbal > apraxia. I am new to all of this and again I would greatly > appreciate any help you give. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2007 Report Share Posted March 21, 2007 We started Aetna on 1-1-07, I had carelink before and they refused to cover st after appeals. Fortunately my employer gives us a few options so we changed to Aetna. we had his pediatrician send a letter of med necessity and his neurologist send a letter stating that apraxia is a neurological disorder and st was me nec. It took some arguing but they agreed to pay for unlimited visits. The code they are using is 784.69 > > Hello all!! > > Anyone who has any info on how to get Aetna to pay for speech > therapy and which codes to use I would be greatful. Therapy costs > really add up and they have an exclusion in their policy to verbal > apraxia. I am new to all of this and again I would greatly > appreciate any help you give. > > Some info on my son...almost 2 yrs old with severe oral and verbal > apraxia. Completely non-verbal at this point. > > It seems crazy to me that this is a neurological disorder and > insurance won't pay for it. They say they will only pay for speech > therapy to bring it back to the point were speech was lost. Do they > expect kids who can't speak to remain that way forever? It is > extremly frustrating. > > I was also hoping to find someone who lives in Louisiana (Lake > ) area that might be able to give some suggestions as to > therapy in my area! > > Thank you for reading, have a good day. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 We don't have Aetna, but our insurance specifically states that they do not cover speech for neurological or developmental reasons. Speech therapy is only covered if lack of speech is due to severe trauma, such as a brain injury and even then they only cover 60 CONSECUTIVE sessions. I know it's crazy. Especially since we have excellent coverage for everything else. I would think that if it wasn't written specifically into the plan as something they do not cover, you should be able to appeal it, especially if you had a letter from a doctor (or several) stating that it is medically necessary. By the way, we have Blue Cross Blue Shield of Delaware. Fran ************************************** AOL now offers free email to everyone. Find out more about what's free from AOL at http://www.aol.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 > > We don't have Aetna, but our insurance specifically states that they do not > cover speech for neurological or developmental reasons. Speech therapy is > only covered if lack of speech is due to severe trauma, such as a brain injury > and even then they only cover 60 CONSECUTIVE sessions. I know it's crazy. > Especially since we have excellent coverage for everything else. I would > think that if it wasn't written specifically into the plan as something they do > not cover, you should be able to appeal it, especially if you had a letter > from a doctor (or several) stating that it is medically necessary. > By the way, we have Blue Cross Blue Shield of Delaware. > > Fran > > > > ************************************** AOL now offers free email to everyone. > Find out more about what's free from AOL at http://www.aol.com. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 Yeah, we tried, but my husband is a state employee. Trying to get the state to do anything like that is a joke. We have a hard enough time finding doctors to accept the plan since we don't live in Delaware (the state he works for). Oh and he works in HR and they still won't help him. Fran ------------------------------------- Assuming you are getting your plan through an employer, it is the employer who decides what " level " of insurance they want to pay for. You may have some luck contacting someone in HR and explaining the problem. As someone else mentioned, their company put a rider on their policy and the speech therapy was covered. ************************************** AOL now offers free email to everyone. Find out more about what's free from AOL at http://www.aol.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 It's actually stated in the policy handbook. Yes, it is a state plan. My husband works for the state of Delaware. We were really surprised because they cover everything else. We discussed it with the benefits people in HR (my husband works in HR so he knows all the higher ups he can talk to) and everyone else we could think of and they won't do anything to help us. Fran -------------------------------- FRAN, I'm trying to read as much as possible on eveyone's insurance. I'm curious does your member handbook with your policy's provisions actually state that speech is not covered for neurological purposes,or did you find that out from appeals which that was stated in the master policy but not actually shown/given to the members? I ask because that is the first time I heard anyone say Neurological disorders are not covered. Oh, also is your Blue cross blue shield of Delaware a state health benefit plan? Thanks--Cheryl- ************************************** AOL now offers free email to everyone. Find out more about what's free from AOL at http://www.aol.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 FRAN, I'm trying to read as much as possible on eveyone's insurance. I'm curious does your member handbook with your policy's provisions actually state that speech is not covered for neurological purposes,or did you find that out from appeals which that was stated in the master policy but not actually shown/given to the members? I ask because that is the first time I heard anyone say Neurological disorders are not covered. Oh, also is your Blue cross blue shield of Delaware a state health benefit plan? Thanks--Cheryl- -- In , morighanne@... wrote: > > We don't have Aetna, but our insurance specifically states that they do not > cover speech for neurological or developmental reasons. Speech therapy is > only covered if lack of speech is due to severe trauma, such as a brain injury > and even then they only cover 60 CONSECUTIVE sessions. I know it's crazy. > Especially since we have excellent coverage for everything else. I would > think that if it wasn't written specifically into the plan as something they do > not cover, you should be able to appeal it, especially if you had a letter > from a doctor (or several) stating that it is medically necessary. > By the way, we have Blue Cross Blue Shield of Delaware. > > Fran > > > > ************************************** AOL now offers free email to everyone. > Find out more about what's free from AOL at http://www.aol.com. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 Assuming you are getting your plan through an employer, it is the employer who decides what " level " of insurance they want to pay for. You may have some luck contacting someone in HR and explaining the problem. As someone else mentioned, their company put a rider on their policy and the speech therapy was covered. M. > > We don't have Aetna, but our insurance specifically states that they do not > cover speech for neurological or developmental reasons. Speech therapy is > only covered if lack of speech is due to severe trauma, such as a brain injury > and even then they only cover 60 CONSECUTIVE sessions. I know it's crazy. > Especially since we have excellent coverage for everything else. I would > think that if it wasn't written specifically into the plan as something they do > not cover, you should be able to appeal it, especially if you had a letter > from a doctor (or several) stating that it is medically necessary. > By the way, we have Blue Cross Blue Shield of Delaware. > > Fran > > > > ************************************** AOL now offers free email to everyone. > Find out more about what's free from AOL at http://www.aol.com. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2007 Report Share Posted March 22, 2007 I was told the same thing. I work for the federal government. I was told I would have to contact someone from HR and ask them to pay for " more " coverage. There was no negotiation as far as the insurance company was concerned. The level is set by the employer who pays for the coverage. > > > > We don't have Aetna, but our insurance specifically states that > they do not > > cover speech for neurological or developmental reasons. Speech > therapy is > > only covered if lack of speech is due to severe trauma, such as a > brain injury > > and even then they only cover 60 CONSECUTIVE sessions. I know > it's crazy. > > Especially since we have excellent coverage for everything else. > I would > > think that if it wasn't written specifically into the plan as > something they do > > not cover, you should be able to appeal it, especially if you had > a letter > > from a doctor (or several) stating that it is medically necessary. > > By the way, we have Blue Cross Blue Shield of Delaware. > > > > Fran > > > > > > > > ************************************** AOL now offers free email to > everyone. > > Find out more about what's free from AOL at http://www.aol.com. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2007 Report Share Posted May 17, 2007 hi - my job is switching to aetna insurance in june. i was just wondering if people have had success with getting aetna to cover a docband from Cranial Tech. thanks, candice, ny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 Hi , I have Aetna insurance. My son wore a Hanger Band from the age of 5-10 mo old. Aetna covered the band at 80% (for me they actually paid 100% since I had met the $1000 out of pocket deductible for last year) My son is currently wearing a Doc Band from Cranial Tech. On Mon, 5/28 will be the end of his 3rd week of wearing it. He is now 14 1/2 mo. old. Aetna does have a clause which I would copy to this email but I am not sure legally wise if I am allowed to which is why I didnt. But anyway it does say that banding must be initiated between 4-12 months of age. Since my son started this treatment when he was 5 mo old I called Aetna and asked them what I needed to do since his treatment was " initiated " in their exact terms within their guidelines and his treatment is still ongoing. They told me I had to file for a pre- determination which basically I had to have my son's neuro send all his medical records to my ins. co, the insurance codes, as well as a statement stating that his treatment started at 5mo and is still ongoing. This pre-deter. takes a little while (apx 4 weeks) so I decided to take a chance and pay out of pocket to CT and am keeping my fingers crossed that Aetna will approve the pre-deter. and cover the 2nd helmet. They will cover it I think at 80 or 85% but hey that's better then nothing! Did you ever bring your daughter for an eval at CT? If so what did they say ? Did she finish her Hanger Band ? How does her head look to you? At my son's 1st adjustment at CT this past Monday I was pleasantly surprised since I am already starting to see him round out on the back part of his head where he was flat!!! Now I am just hoping to see some growth on his right side of his head where I see most of the flattening. Keep me posted on how things are going! Best of luck to you Mom to CJ- 14 1/2 mo old DOC Band 4/30 > > hi - my job is switching to aetna insurance in june. i was just > wondering if people have had success with getting aetna to cover a > docband from Cranial Tech. > > thanks, > candice, ny > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 hi- thanks for your reply. my daughter started her hanger band at 9 months,so this would be under the 12 month mark for aetna. i stopped using the hanger band soon after she turned 12 months because i started to become skeptical about its effectiveness. i think her head looks good, but i still have those days when i look at it and it looks weird. i have always wanted to go to CT since i found out about them, but my prior insurance was not in their network. so i think i will give it a try with aetna. thanks, candice, nycathyl65 <cathyl65@...> wrote: Hi ,I have Aetna insurance. My son wore a Hanger Band from the age of 5-10 mo old. Aetna covered the band at 80% (for me they actually paid 100% since I had met the $1000 out of pocket deductible for last year) My son is currently wearing a Doc Band from Cranial Tech. On Mon, 5/28 will be the end of his 3rd week of wearing it. He is now 14 1/2 mo. old. Aetna does have a clause which I would copy to this email but I am not sure legally wise if I am allowed to which is why I didnt. But anyway it does say that banding must be initiated between 4-12 months of age. Since my son started this treatment when he was 5 mo old I called Aetna and asked them what I needed to do since his treatment was "initiated" in their exact terms within their guidelines and his treatment is still ongoing. They told me I had to file for a pre-determination which basically I had to have my son's neuro send all his medical records to my ins. co, the insurance codes, as well as a statement stating that his treatment started at 5mo and is still ongoing. This pre-deter. takes a little while (apx 4 weeks) so I decided to take a chance and pay out of pocket to CT and am keeping my fingers crossed that Aetna will approve the pre-deter. and cover the 2nd helmet. They will cover it I think at 80 or 85% but hey that's better then nothing!Did you ever bring your daughter for an eval at CT? If so what did they say ? Did she finish her Hanger Band ? How does her head look to you? At my son's 1st adjustment at CT this past Monday I was pleasantly surprised since I am already starting to see him round out on the back part of his head where he was flat!!! Now I am just hoping to see some growth on his right side of his head where I see most of the flattening.Keep me posted on how things are going!Best of luck to youMom to CJ- 14 1/2 mo oldDOC Band 4/30>> hi - my job is switching to aetna insurance in june. i was just > wondering if people have had success with getting aetna to cover a > docband from Cranial Tech.> > thanks,> candice, ny> Luggage? GPS? Comic books? Check out fitting gifts for grads at Search. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 , Good luck to you and please feel free to ask any questions you may have and I will do my best to try and help or answer anything for you! Mom to CJ- 14 1/2 mo old Doc Band 4/30 > > > > hi - my job is switching to aetna insurance in june. i was just > > wondering if people have had success with getting aetna to cover a > > docband from Cranial Tech. > > > > thanks, > > candice, ny > > > > > > > > > --------------------------------- > Luggage? GPS? Comic books? > Check out fitting gifts for grads at Search. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 Hi , We had two DOCbands covered for our daughter... at 100% by Aetna. The first one she received at 10 months old, the second one she received at 14 months old. Our plan is out of Massachusetts. The first time we needed a pre-authorization from AETNA (which we got).. then a few months later, AETNA contracted with Cranial tech and we no longer needed to get a pre-authorization. The second helmet was billed and paid for with no extra steps or pre-authorizations. HTH, Colleen aetna insurance hi - my job is switching to aetna insurance in june. i was just wondering if people have had success with getting aetna to cover a docband from Cranial Tech.thanks,candice, ny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 awesome! so they are contracted with CT? this is definitely something that i have to pursue now. my daughter is 15 months, but maybe i can get better correction. did you still need a prescription and letter of necessity from the doctor? candice, ny">^.^<" <two_soulmates@...> wrote: Hi , We had two DOCbands covered for our daughter... at 100% by Aetna. The first one she received at 10 months old, the second one she received at 14 months old. Our plan is out of Massachusetts. The first time we needed a pre-authorization from AETNA (which we got).. then a few months later, AETNA contracted with Cranial tech and we no longer needed to get a pre-authorization. The second helmet was billed and paid for with no extra steps or pre-authorizations. HTH, Colleen aetna insurance hi - my job is switching to aetna insurance in june. i was just wondering if people have had success with getting aetna to cover a docband from Cranial Tech.thanks,candice, ny Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's updated for today's economy) at Games. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 , Payton's was covered 100% by Aetna as well. I hope it works out for you! Payton 6 months, DOC Band, Phoenix > Hi , > > We had two DOCbands covered for our daughter... at 100% by Aetna. The first one she received at 10 months old, the second one she received at 14 months old. Our plan is out of Massachusetts. The first time we needed a pre-authorization from AETNA (which we got).. then a few months later, AETNA contracted with Cranial tech and we no longer needed to get a pre-authorization. The second helmet was billed and paid for with no extra steps or pre-authorizations. > > HTH, > Colleen > > aetna insurance > > > hi - my job is switching to aetna insurance in june. i was just > wondering if people have had success with getting aetna to cover a > docband from Cranial Tech. > > thanks, > candice, ny > > > > > > > > > --------------------------------- > Boardwalk for $500? In 2007? Ha! > Play Monopoly Here and Now (it's updated for today's economy) at Games. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 Yes they are contracted with them now. We needed a prescription both times as well as a letter of medical necessity. If you call cranial tech, they will give you a list of doctors that prescribe DOCbands as their preferred choice. The cranial facial surgeon that my daughter saw was one of the doctors that used Cranial Tech, so they were used to working with him. So I didn't need to try and convince him to use a DOCband over a Hanger, etc, he knew exactly what letter of medical necessity they needed and he gave everything to cranial tech directly including the prescription, so I didn't need to transport all that stuff back and forth. It was very easy. I never spoke with Aetna about the helmet, cranial tech did the whole thing (which is good because Aetna's customer service is AWFUL). Aetna gave us no problem with starting the next band after 12 months since she had started treatment before 12 months with the first helmet. I would get on it right away though, since the 18 month mark is approaching and I would think it might be harder to make your case if they give you trouble since the research suggests banding before 18 months. HTH! Colleen aetna insurance hi - my job is switching to aetna insurance in june. i was just wondering if people have had success with getting aetna to cover a docband from Cranial Tech.thanks,candice, ny Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's updated for today's economy) at Games. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Colleen The info you provided was very helpful! I feel like they def. should approve me now! I will call them next week and see what they say. I will probabaly only get my band covered at the 85% tho since my job breaks down our ins. into 3 options. One being the best option since they cover everything at 100% and option 2 & 3. I have option 2. Both any coverage is better then nothing!! Thanks! Mom to CJ- 14 1/2 mo old. Doc Band 4/30 > Hi , > > We had two DOCbands covered for our daughter... at 100% by Aetna. The first one she received at 10 months old, the second one she received at 14 months old. Our plan is out of Massachusetts. The first time we needed a pre-authorization from AETNA (which we got).. then a few months later, AETNA contracted with Cranial tech and we no longer needed to get a pre-authorization. The second helmet was billed and paid for with no extra steps or pre-authorizations. > > HTH, > Colleen > > aetna insurance > > > hi - my job is switching to aetna insurance in june. i was just > wondering if people have had success with getting aetna to cover a > docband from Cranial Tech. > > thanks, > candice, ny > > > > > > > -------------------------------------------------------------------- ---------- > Boardwalk for $500? In 2007? Ha! > Play Monopoly Here and Now (it's updated for today's economy) at Games. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Good luck! I hope it works out for you! Best wishes, Colleen aetna insurance> > > hi - my job is switching to aetna insurance in june. i was just > wondering if people have had success with getting aetna to cover a > docband from Cranial Tech.> > thanks,> candice, ny> > > > > > > --------------------------------------------------------------------> Boardwalk for $500? In 2007? Ha! > Play Monopoly Here and Now (it's updated for today's economy) at Games.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2009 Report Share Posted September 15, 2009 When I took my son to the first Neurologist he said he had Verbal Apraxia and that he was going to put down possible PDD-NOS otherwise they will not give him service. The code my son speech therapist use is 784.69 and 315.32 I hope this help. Tracey ________________________________ From: wbuckalew1 <wbuckalew1@...> Sent: Tuesday, September 15, 2009 12:24:47 PM Subject: [ ] Aetna insurance  Any one have troubles with Aetna paying for speech therapy? I am trying for 6months for them to cover it trying a new medical code this time to see if that will work. I have talked to the therapist and doctor to use code 781.3, but they said that it is not verbal apraxia code. I am trying to tell them I know that but, I need a code that will get the insurance to cover something. RRRRR... so frustrating, I feel like they dont understand and I will never get this done. Winter Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2009 Report Share Posted September 15, 2009 Look to your Certificate of Coverage to see what the insurance should be covering. > > Any one have troubles with Aetna paying for speech therapy? I am trying for 6months for them to cover it trying a new medical code this time to see if that will work. I have talked to the therapist and doctor to use code 781.3, but they said that it is not verbal apraxia code. I am trying to tell them I know that but, I need a code that will get the insurance to cover something. RRRRR... so frustrating, I feel like they dont understand and I will never get this done. > Winter > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2009 Report Share Posted September 16, 2009 I have Aetna POSII (which is like a PPO). It really depends on your specific plan. Read the fine print of the policy. I just had to fight them to cover more occupational therapy. They denied us visits after the initial 60 days worth of therapy. Luckily my sons pediatrician spoke to the insurance medical director and convinced her all of his issues (severe apraxia, dyspraxia, hypotonia and sensory processing dysfunction) are medically based, NOT developmental in nature. It helps that my son has dysmorphic facial features, so it comes back to a possible chromosomal abnormality. He has speech therapy right now also, but it is for feeding therapy...not actual speech. Unfortunately, right now I have better luck fighting the school district for more speech therapy! -Jenna > > Any one have troubles with Aetna paying for speech therapy? I am trying for 6months for them to cover it trying a new medical code this time to see if that will work. I have talked to the therapist and doctor to use code 781.3, but they said that it is not verbal apraxia code. I am trying to tell them I know that but, I need a code that will get the insurance to cover something. RRRRR... so frustrating, I feel like they dont understand and I will never get this done. > Winter > Quote Link to comment Share on other sites More sharing options...
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