Early intervention

chicagobride_07

Because of LOs birthweight, the NICU referred us to early intervention. We received a call from them about a month after discharge. Both neo and pedi say LO is on track, but could benefit from some PT for a neck issue. I am trying to understand the advantages of using early intervention as opposed to just seeking out a PT on our own and using insurance. In my initial talks with EI! They are going to both use our insurance and charge us a 200 per month family fee due to our income. If we were low income and had no insurance, everything would be free. Should I just forget about the early intervention and go privately and use our insurance?

chicagobride_07

This is the early intervention program through the state of illinois

jbranden12

Are you sure the $200 isn't a maximum payment amount and not a fee? So, Anna receives PT, OT, and specialized skills training twice each month. ECI bills our insurance and we would be billed if anything wasn't covered with a max of a specific amount per month. They don't bill us the monthly fee in addition to billing our insurance. If you used only private insurance and the policy required co-pays that added up to more than your monthly fee, ECI would be the way to go.

If LO only needs PT and you have great insurance, you could go privately. But if it's possible LO might require more services in the future, it would be helpful to already be enrolled with ECI because then you could just request an eval from another provider. 

jacque_z

EI is totally free in our State (OK).  I never provided any insurance info. 

Pips09

Our EI is also free; we never went through insurance. The benefit to EI, for us, in addition to being free, was that they coordinated all care. So when we decided we needed a speech evaluation, our coordinator set it up for us, in addition to the OT. I didn't have to do any extra leg work. They also worked with our schedule, and came to our house.

Lisa92281

Are you sure you don't only have to pay the fee if insurance doesn't cover the therapy?  My son has been receiving PT and OT once a week through EI for 2 months now, (we're in Illinois) and we were told we only had to pay a monthly fee (based on income) if insurance didn't cover it.  Insurance covers it and we haven't had to pay anything.

DrRx

I thought that EI was a federally funded program that, although they try to bill insurance, if in the end they don't cover it, they use the money that the federal government supplies.  I know that all the states administer it differently, but I would do some investigation for their program on their website to see exactly what they require. 

DD has been getting EI since we were discharged from the NICU, and I've never paid a dime.  I know that my insurance doesn't pay for it, since I get the EOBs saying that it isn't a service that is covered, but I've never received a bill from the therapists. 

Right now, DD has the EI person come once a week, but we haven't been referred to PT or speech.  However, we might do speech soon since DD doesn't have any words yet and she is 18 months.  I definitely think that it has helped TREMENDOUSLY in helping DD close the gap and hit milestones. 

thishappyhouse

EI is run differently in each state.  I am in CT and our EI structure is very similar to yours.  EI bills our insurance company but then there is also a sliding scale "family fee"  that covers as many services that any child under 3 in your household needs.  Unfortunately our family fee is $225/ month  I have continuously debated going to private therapies because we would have no out of pocket expenses since we meet our deductible every year anyway.  I didnt go this route initially because I did not want to expose my DD to a therapy center during RSV season.  We will revisit the idea again after our next evaluation and when we know what services she will be need for the next 6 months to a year.  

If you dont need services beyond PT it may make sense to go to a private therapist.  My DD has gotten weekly PT for the past year and a half and at different times has also received ST and OT so it sorta has made sense for us to stay enrolled in EI despite the costs.  

good luck!

LegallyBlonde217

jbranden12 said:

Are you sure the $200 isn't a maximum payment amount and not a fee?

This is exactly what it is.  I'm also in IL and we had our twins evaluated a couple months ago.  The $200 is a maximum monthly payment that may have to be paid only if insurance doesn't cover it.

MrsRKJ

I'm in NY too, but I was told EI is totally free.  Our case worker didn't even take our insurance info.  DS is going to get PT & OT

chicagobride_07

Thanks ladies. I am going to have the EI evaluation for LO next week and go from there.

MinaE01

LegallyBlonde217 said:

jbranden12 said:

Are you sure the $200 isn't a maximum payment amount and not a fee?

This is exactly what it is.  I'm also in IL and we had our twins evaluated a couple months ago.  The $200 is a maximum monthly payment that may have to be paid only if insurance doesn't cover it.

We just had DS evaluated in IL (SW of Chi burbs), and this is my understanding, too. Definitely go through with the eval. Even if LO doesn't qualify, you still may receive some good advice and suggestions from the PT and OT that will come out. DS didn't qualify, but we got a referral to an excellent Pediatric GI that we've just begun seeing.

zoeyandsummersmom

thishappyhouse said:

EI is run differently in each state.  I am in CT and our EI structure is very similar to yours.  EI bills our insurance company but then there is also a sliding scale "family fee"  that covers as many services that any child under 3 in your household needs.  Unfortunately our family fee is $225/ month  I have continuously debated going to private therapies because we would have no out of pocket expenses since we meet our deductible every year anyway.  I didnt go this route initially because I did not want to expose my DD to a therapy center during RSV season.  We will revisit the idea again after our next evaluation and when we know what services she will be need for the next 6 months to a year.  

If you dont need services beyond PT it may make sense to go to a private therapist.  My DD has gotten weekly PT for the past year and a half and at different times has also received ST and OT so it sorta has made sense for us to stay enrolled in EI despite the costs.  

good luck!

We are also in CT and in a similar situation. We have become so close to our EI team, that we are sticking with them for the full 3 years. I also think they will be very helpful in the transition to preschool. 

takmjs

Lisa92281 said:

Are you sure you don't only have to pay the fee if insurance doesn't cover the therapy?  My son has been receiving PT and OT once a week through EI for 2 months now, (we're in Illinois) and we were told we only had to pay a monthly fee (based on income) if insurance didn't cover it.  Insurance covers it and we haven't had to pay anything.

I think this is what ours is, and we're in Wisconsin. We provided our insurance info, and she looked at our income level from last year. I'm pretty sure she said we only pay monthly if insurance doesn't cover it, and I assume insurance is covering it, because we have yet to receive a bill.