new apraxia dx - ins. denied speech therapy
WYEngTeacher
member
My DD was recently diagnosed with apraxia of speech by a private SLP. We've been getting speech therapy through EI, but we really need to start her in additional therapy asap with this private speech therapist. Her EI SLP doesn't use PROMPT (the private does) and I feel like she really doesn't know what to do with DD... she admits she doesn't have much experience with apraxia. Anyway, our insurance (Blue Cross) has actually denied us coverage because they say her need doesn't meet the "medical criteria" of our policy. We appealed, and the "medical director" told the private SLP that our policy is written so as to only cover speech therapy needs that result from an accident or stroke, etc. In that case, we would get 100% for 50 visits per year. I just don't understand how they can say a condition such as apraxia isn't a medical need...???
Does anyone on here have any experience or advice regarding battling insurance companies?
Re: new apraxia dx - ins. denied speech therapy
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I was in a very similar position as you are when my son received the Apraxia dx. The speech therapists through EI really didn't know what to do with him and while the other therapists were great, the SLP we were assigned to didn't work well with our son. Trevor was non-verbal @ 3, had limited signs, and used gestures, grunts, and limited sounds to get he needs met. Our insurance did cover speech, but only until the school system started picking up the tab. We were able to get private speech for about 6 months then we were told our insurance would no longer cover the service.
We also had trouble finding a private SLP who had experience with children with "severe" Apraxia which Trev was labeled as. There was only one therapist in the practice who could work with him.
Once he entered the school system, he blossomed! Within 6 months he was saying intelligible words and by the end of the first year in pre-k he was speaking in phrases. He received intensive speech services throughout the school year - including summer and was in a language needs pre-k classroom.
I know my response doesn't have a ton to do with fighting insurance companies, but just wanted to let you know that there is hope and that the school system may be your best bet. Today, Trevor is 5.5 yo and actually tests in the normal range for articulation. The SLP claims he is 100% intelligible..
I have a blog (in sig.) that is mainly about our journey. Feel free to page me.
Thank you so much for all the replies! It seems this board gets a lot more "apraxia" related activity than the apraxia-kids.org boards that I'd been perusing.
Auntie - Your post was extremely informative and I'm going to be looking into the medicaid stuff. I have requested an SLP trained in PROMPT from our EI service coordinator, but she said she didn't think there were any that serviced my area.
As nice as she is, I really don't think our current SLP knows where to begin with DD. She openly admits that she doesn't have a lot of experience with apraxia. Where are you in SE PA? My undergrad is from WCU and my SIL lives in Langhorne. 
::edit:: duh, just saw that it's New Hope 
Meghans - Your story gave me so much hope and was really uplifting. Thank you so much for sharing. These are the kind of stories that I'm thriving on right now....
rsweethart - YGPM back
My insurance won't cover a private SLP either. We are paying OOP.