ASD families - What services do you pay for? — The Bump
Special Needs

ASD families - What services do you pay for?

I am curious, if your child has an ASD, what services do you pay for?  How old is your DC?

I ask because I see so many referances to paying for services.  Maybe I am just lucky, but I haven't had to pay a single penny for my son's services.  He was first evaluated my early intervention when he just after his second birthday.  He qualified for services and the county sent a special instuction teacher, OT and ST to our home weekly plus a enrolled him in a weekly playgroup where they actually paid me to transport him.  Early Intervention also paid for our evaluation with the pedi specialist.  When he turned 3, he transitioned to the preschool for services.  He is bussed to preschool 5 days a week where he recieves all his therapies.  Again, I don't pay a penny.  It is all funded by the state and county, and ran by the school district. 

Re: ASD families - What services do you pay for?

  • Our little one is only 3 but as of now we pay for private OT and are startign private PT.
  • before my son was 3 - he got EI through the State (NJ) -- unfortunately the state thought we were "rich" (we aren't) and they applied a sliding scale formular for our cost share - which ended up being about 600 - 700 a month. 

     After he turned 3 - he was eligible for the pre-school program.  which - with busing - is totally FREE (thank god).

    however, I am looking into outside therapies as well - apparently our insurance may cover speech - but not any other services, e.g., ABA, etc. which is totally ridiculous.

     Sounds like you have a good deal -- that really helps.  I hate that economics has anythign to do with our son (and all ASD kids) getting the services they need.

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  • image snowiebride:

    before my son was 3 - he got EI through the State (NJ) -- unfortunately the state thought we were "rich" (we aren't) and they applied a sliding scale formular for our cost share - which ended up being about 600 - 700 a month. 

     After he turned 3 - he was eligible for the pre-school program.  which - with busing - is totally FREE (thank god).

    however, I am looking into outside therapies as well - apparently our insurance may cover speech - but not any other services, e.g., ABA, etc. which is totally ridiculous.

     Sounds like you have a good deal -- that really helps.  I hate that economics has anythign to do with our son (and all ASD kids) getting the services they need.

    NJ bas a law stating that insurance companies MUST pay for all therapies for children who are on the spectrum.
  • If my ds was in the school system, he would have had free services. 4 full day preschool program, 4, 30 minutes ST sessions per month and 4 1 hr group OT sessions with free transportation. The problem is, we live out in the boondocks where services are not up to par according to my standards. And we fought for ABA and lost. So, we purchased a private policy, $165 per month, with a $1500 deductible, that pays for every single dime of his ABA, and up to 20 visits each to ST and OT. We ran out of OT and ST rather quickly this year, so we are paying out of pocket for those right now, 2x OT at $85 a pop, and 1 x ST at $100 a pop. Our state of residence, IN, mandates coverage for services with no cap, related to ASD, but can limit visits for OT and ST.

    Which is why we are switching to my employers insurance next year, which is actually based out of KY (we live right on the border btw IN and KY). They have a new law, eff Jan 2011, which includes $40K cap limit per year, but no limits to OT and ST can be placed if it is related to ASD. So it will actually save us money. So really, we will be spending less for my family policy then we did for ds group policy, with a lower deductible ($750 for ds). The only thing we will pay for is 10% of all his services with a yearly max out of pocket for him of $2250. Pretty good deal.

  • I also live in NY, and yes we are very lucky not having to pay for services. We are currently getting ABA, OT and ST.

    Just today we looked at school so they can get more ABA therapy and EI will also pay for the school and transporation for both my boys.

     

  • I am in TX. I pay for private ABA, private OT and private speech. ECI is a joke, and you still pay on a sliding scale. Private provider are very expensive. NOTHING is covered by my insurance with the diagnosis code we have. I am really lucky, I know.

  • We are fortunate to have a very well respected school program available to us, but unfortunately it doesn't provide all of the services that I know that my son needs, either in scope or in quantity. DS attends an ASD pre-k program offered by the school district M-F, 8-2 where he receives speech and OT. Those services are free. Additionally, he goes to a private ST 2x a week and receives 6 hours of private ABA (which is not offered by the school system). Those services are covered by our insurance, however, we are still responsible for co-pays. We were only recently able to find an in-network provider for ABA though, so from Feb-August, we paid out of pocket for that to the tune of anywhere from $25-65/hour (depending on the therapist, we have had several). We also have co-pays for his visits with the developmental pedi/psych who manages his medication, and a small co-pay for his rx (thank God for Target and generics :)).

    If you're satisifed with the tx your DS is receiving through the school and he's making progress, then I would consider yourself very fortunate. :) 

    DS1 9/7/05 DS2 10/20/07 DS3 1/20/09 DD 11/9/14
  • image mommyof4boys:
    image snowiebride:

    before my son was 3 - he got EI through the State (NJ) -- unfortunately the state thought we were "rich" (we aren't) and they applied a sliding scale formular for our cost share - which ended up being about 600 - 700 a month. 

     After he turned 3 - he was eligible for the pre-school program.  which - with busing - is totally FREE (thank god).

    however, I am looking into outside therapies as well - apparently our insurance may cover speech - but not any other services, e.g., ABA, etc. which is totally ridiculous.

     Sounds like you have a good deal -- that really helps.  I hate that economics has anythign to do with our son (and all ASD kids) getting the services they need.

    NJ bas a law stating that insurance companies MUST pay for all therapies for children who are on the spectrum.

    These laws vary by state, so NJ could very well be different, but we have a similar law here in FL, and there are loopholes that allow insurance companies to opt out-- if you have private insurance, if your insurance plan through your employer is self-funded, if the insurance policy doesn't have a minimum numbers of employees on it, if the actual policy itself is written out of state (don't ask me how that works, but I know several families whose insurance has denied their ASD claims because of this), etc.

    snowiebride: It's definitely worth asking your insurance company what your ASD benefits are-- if your policy meets the NJ criteria, then they should be able to tell you that.

    edited to add the link to the FAQs for the NJ Autism law (see questions 3 and 4 as to which companies must comply):

    http://www.autismvotes.org/site/c.frKNI3PCImE/b.4172687/k.2867/New_Jersey.htm

    DS1 9/7/05 DS2 10/20/07 DS3 1/20/09 DD 11/9/14
  • We have all of our therapies covered as well, between the District and the Regional Center (before he was 3 it was Reg Ctr only, which included EI). I know we're lucky that our excellent school is free, ABA shadow at school is free, including ST, OT at school as well as private ST are also covered for us. We used to have ABA for 1.5 years for free as well. Regional Center also covers 12 hrs/month for respit services.

    What we pay for is essentially what we choose "above and beyond", like DS's DAN doc, all his supps and everything that supports special diet. We paid a portion for devel. pedi's visits, but we haven't been in a while (didn't see the necessity in the past year). I also want to send him to music therapy, which neither the District nor the Regional Center recognize as "necessary" therapy, along with things like horse-back riding therapy and a few other things they view unconventional or whatever. To me, it seems important and I know my son develops through music, so I will go and pay for that out of pocket. Nothing is pushing me to do it, no doctor is telling me to do it....I just feel it would help him, so I'm gonna pay for it.

    Other than that, I'm very grateful that the "necessary" services are free to us.

  • I cannot speak to ASD, but did want to add this about paying for therapies.  In my state, EI therapies are paid for on a sliding scale based on income.  For us, there is no OOP cost because my insurance pays for what EI doesn't (although I am very well aware that I am paying for it through our premiums--just don't have to cut a seperate check).  Our insurance also pays for her private feeding therapy, but does have a # visits cap. 

    One thing I have learned is to force your insurance to get very specific with you and to put it in writing.  I always call ahead to make sure xyz is covered and then ask them for a letter.  They always say "Oh, that isn't necessary.  It is in your policy."  Get it anyways.  I had to use it once when they tried to argue with me about one service.  Hard to when you have it on their own letterhead.

     

  • For EI it was mainly speech - and insurance covered it.

    Now that he is in the school system he goes to a SN preK 5 days a week, half days (he gets OT and speech there). At this time we don't have him in anything else - we are waiting to hear his progress report from his teacher to see how his IEP will adjust after the first quarter. He goes to a regular daycare the other half of the day.

    We are very fortunate that he qualified for 5 days preK because not many do qualify for that much.

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  • Our son is 4 1/2.  We have to pay for all OT, all ST, $45 for 1.5hrs a week of social group.  All his neurologist and D.A.N. dr. visits are paid out of pocket first then we have to submit and hope we get some of it back.  Neither dr. accepts insurance because the Autism diagnosis is too risky to get reimbursement I guess. Many of his blood tests work the same way as well.  We tried Floortime Therapy, but at $130hr every week was just too much. 

    Our state has an Autism scholarship, which we use for his education, but we still pay out of pocket because its not enough to cover the expenses.  Money is really tight even though we both work.  If insurance companies had to pay for basic autism therapies both our child and our budget would be better off.

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