Re: Re: Question about insurance- medicaid coverage for spe...

[Guest guest]

OK we live in Ohio to but has private insurance through his father and

gets Medicaid through SSI

[ ] Re: Question about insurance- medicaid coverage

for spe...

OK dumb question, but how do you have Medicaid and private insurance?

Our private ins. doesn't pay for ST unless it's due to an illness or

injury, so they won't pay for our son's ST, it's all out of pocket,

which is why we've opted for the school's ST. I swear we would be

broke if my son actually got the ASHA recommended ST (3-5 x a week).

At $50 a session, I just can't afford it and add to that there are no

SLP's in my area, we have to drive at least 1 hr round trip to a SLP,

plus we both work FT, that's all I'd be doing is driving to/from ST!

We do a lot of " home work " . I'm considering it for over the summer

though. We live in Ohio, not sure if different states have different

policies. Thanks for the info.

Bonnie

[Guest guest]

I know this sounds so silly, but we asked the school for as much of all

therapies as they would offer, and the therapists have been fantastic about

offering homework for our daughter. We have been her primary therapists for

years, but have used them for alot of guidance. She has improved greatly. When

we did both private and school therapy, they were often at odds with one

another. This helped us alot. We made this part of her daily work. S-TH.

Weekends off. The therapists have been happy to do this for us.

Debbie <Mistyangel66@...> wrote: Morning everyone.

I usually just lurk and read on this group but since this is an

issue I ran into this week I felt the urger to post.

My son who has Down syndrome used to be on FL medicaid. Not a problem

with any of his therapies. They did only cover so many but it was

enough. He had three sessions a week ot, pt, and st at 30 mins a

session. The schools do not provide adequate therpay for Apraxia.

However, I have recently had to switch to the state insurance, and I

am on the high end of it because of income. I pay an atronomical

amount for his insurance. I found out this week that they are not

going to cover his therpaies, because they are not preferred

providers. Ok, so I went and looked well there isn't any within 300

miles of me that work with special needs. I am outraged, and at a

loss. IF anyone is out there from FL any advice.

Thanks,

Debra

[Guest guest]

Most insurance companies have to cover an out of network provider at the in

network rate and policy guidelines if there is no in network provider

available. Having to go 300 miles each way for speech therapy SHOULD meet

this guideline. Have you called the insurance and spoken with someone?

I've had to go this route many times for pediatric neurologists and ER

visits as our local ER wasn't covered and there was absolutely no ped neuro

on our insurance plans. It wasn't appropriate for my son to see an adult

neuro and it certainly wasn't appropriate to travel over an hour to an ER

for an actual emergency!

Miche

On Thu, Feb 14, 2008 at 5:38 AM, Debbie <Mistyangel66@...> wrote:

> Morning everyone.

> I usually just lurk and read on this group but since this is an

> issue I ran into this week I felt the urger to post.

> My son who has Down syndrome used to be on FL medicaid. Not a problem

> with any of his therapies. They did only cover so many but it was

> enough. He had three sessions a week ot, pt, and st at 30 mins a

> session. The schools do not provide adequate therpay for Apraxia.

> However, I have recently had to switch to the state insurance, and I

> am on the high end of it because of income. I pay an atronomical

> amount for his insurance. I found out this week that they are not

> going to cover his therpaies, because they are not preferred

> providers. Ok, so I went and looked well there isn't any within 300

> miles of me that work with special needs. I am outraged, and at a

> loss. IF anyone is out there from FL any advice.

>

> Thanks,

> Debra

>