It has been recommended that my son have speech and sensory therapy twice a week. This amounts to 400.00 per week. What avenues have you guys traveled when insurance refuses to pay? Are there ICD-9 codes that are more often covered?
During the regular school year he is attending school and receives services, but they are still recommending outside help during the summer. I've enrolled him in a developmental preschool but that is only days a week. I just don't have the experience yet to navigate the way and was hoping for some suggestions.
Thanks.
During the regular school year he is attending school and receives services, but they are still recommending outside help during the summer. I've enrolled him in a developmental preschool but that is only days a week. I just don't have the experience yet to navigate the way and was hoping for some suggestions.
Thanks.
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SF Bay Area
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Re: Not Covered?
Mon, June 30, 2008 - 9:11 PMoh please dont fall for that
research other methods/treatments unless you have money to burn , but still, it is probably a waste of time
i am more and more of the opinion that these things work themselves out eventually, even if more slowly than 'normal' children ....
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Re: Not Covered?
Mon, June 30, 2008 - 9:44 PMI'm not sure what you mean by don't fall for that. Which part?
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Re: Not Covered?
Tue, July 1, 2008 - 5:54 AMsynerGy, what do you mean by "these things work themselves out eventually"? Can you reiterate more plainly?
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Re: Not Covered?
Tue, July 1, 2008 - 5:52 AMSandy, how old is your son? You said that he's in preschool, but if he's under three years old, you should definitely contact your country's Early Intervention office. Every county is required by law to have an Early Intervention service for children under three years old, and every school district is required by law to provide services to children over three years old if they qualify for services. That's sort of the tricky part: who determines that they qualify for services, and how and where you go to have your child evaluated.
The place to start is with whoever recommended that your son needs the therapies that he's receiving. Did he receive a diagnosis of some sort? Speech Delay, Sensory Integration issues, Autism, PDD, anything like that? Does he have an IEP with the school? Are you aware that if it is determined necessary by the CSE (a committee of which YOU are a member), that the school is required by law to provide summer services (or at least pay for them) for your son? And if you are the only member of the CSE who thinks that, you still have legal recourse to go to arbitration to settle the dispute? That is likely to take a very long time, mind you, probably longer than the summer, but at least it sets the stage for the next year and the year after.
There are lots of avenues that you can travel, but unfortunately you mostly have to navigate them on your own. Are you familiar with a web site www.wrightslaw.com/ I highly recommend it as a resource to help navigate your way through the federal laws regarding the education of individuals with disabilities, but it also may have some state resources as well. Also, it might help for you to find an advocacy group for people with disabilities in your area, where you can get some specific answers about what programs are in place in your state and county to help you with this sort of thing.
Best of luck, and please let us know how it goes. -
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Re: Not Covered?
Tue, July 1, 2008 - 11:27 PMThanks for all the info Heather. He's 41/2 and his original IEP (done in Aug. of last year) had him as a language/develpment delay. At the conference I had with them in Apr they said at his next IEP they wanted to change that to High Functioning Autism. A year ago I had him evaluated by a developmental pediatrician and it was determined that he didn't show aspects of Autism, so this really threw me for a loop.
I'm going to read over your post and links. I'm sure I'll be back with questions. I really appreciate your taking the time to respond. -
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Re: Not Covered?
Wed, July 2, 2008 - 12:13 PMFinding funding for therapy can be a bear, but it's out there. Your state may have programs that will provide funding for qualifying children - definitely check with local advocacy groups, which may have information not readily available elsewhere. Also, you can call your state EIS and they may be able to point you in a funding direction.
Unfortunately, you need a definite diagnosis for a disorder (ASD, etc) in order to tap into many of those funds. I think people "on the fence" - needing therapy but not meeting the criteria for ASD - have the hardest time finding money. I don't know if that's why your IEP group wanted to classify your son as high-functioning Autism - it's a tough diagnosis to take, but it does open up funding avenues. If you do qualify for funding, though, be prepared to wait - we were on a waiting list for about six months before we got state funding for my son's therapy. I learned all kinds of creative ways to serve Tap Ramen then, I can tell you.
Good luck!
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Re: Not Covered?
Wed, July 2, 2008 - 2:51 PMLook on his IEP from last year and see if it stated "year round services". If so, the school district has to provide them - if not, then you'll know to ask about that for his upcoming IEP meeting this August.
When my son was preschool age and had speech therapy through the school district it was also discontinued over the summer, but they gave me some really easy things to do with him at home. It amounted to about 10 minutes a day (as opposed to two longer sessions per week during the school year) and he improved so much over the summer they dropped him in the fall - which was aggravating because he still wasn't where he was supposed to be. The didn't put him back in speech therapy again until 2nd grade when he again fell below the 70% mark.
For what it's worth I wouldn't get too caught up in what someone says your son's diagnosis is. There are so many conditions that have overlapping traits/symptoms/challenges that it can end up being no more than a matter of opinion. As kids get older it's easier to figure out what "it" is, but even then any LD or ED traits are treated symptomatically anyway. With my kids I got to the point where I just said, "As long as the kids are getting the services they need the professionals can call it whatever they want." -
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Re: Not Covered?
Wed, July 2, 2008 - 9:38 PMLot's of great info. Thanks you guys. -
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Re: Not Covered?
Thu, July 3, 2008 - 5:48 AMI agree. Don't get emotionally invested in the actual diagnosis. You know you kid's strengths and weaknesses, and no diagnosis will change who he is and how he behaves and learns. What a diagnosis will change is the level of services that he receives (at someone else's expense), so don't be intimidated by the suggestion of autism.
Also, something to keep in mind about summer services (and this has always pissed us off, but it's the law) is that the goal of summer session on an IEP is maintenance of skills, not skill gains. The school district is only required to provide services to the point that the student doesn't lose skills gained in the previous school year, not necessarily to progress the child farther. That irks us every summer when they yank our son's OT services and Music therapy, but for him, he's not at risk of making educational losses without those services, and they're probably right. Last year, they tried to trim his speech down to three sessions a week in the summer (at nearly seven years old, he's still non-verbal), but I had a good old fashioned hissy fit and they bumped it back up to five. They did not try to trim it again this summer, so do not underestimate the power of making your voice heard loudly and don't worry about people thinking of you as "that bitchy parent". Better be a bitch than have your kid not get when he needs. -
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Re: Not Covered?
Thu, July 3, 2008 - 6:31 PM"do not underestimate the power of making your voice heard loudly and don't worry about people thinking of you as "that bitchy parent". Better be a bitch than have your kid not get when he needs"
YEAH! Say it like it is! I've done this myself, my son gets what I ask for and now the teachers even come to me for advice. It probably sounds redundant, but YOU are your child's best advocate. The fact that you are out here asking for advice suggests that you are an awesome parent as well! Have courage and go get 'em tiger!!!!!
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