EI services and Private Services at the same time?

brlindy · September 2011

So we have been getting EI services (OT and ST) for about 3 months now and it's been going pretty well. We had been on the wait list at our local Children's Therapy Center for a good 9 months for a regular Speech therapy slot and we just got the call yesterday that they finally have a spot for him. So I jumped on that chance. However, our OT therapist just informed me that you aren't allowed to get services from two different places at one time.

Is this true? Why can't I still get the EI services through the state and use our insurance for the private therapy?

If I have to choose between the two, is one considered better than the other?

I'm just wanting to get as many hours of help for my little guy as possible.

baylorflamingo · September 2011

This gets a side eye from me. But, maybe it is a state by state issue. I would contact your service agency and ask them - don't go on just what your OT says.

Justinlove · September 2011

Check with your state. I have heard that some (those that do not charge your insurance) do not allow you to get the free EI if you are paying privately at the same time.

In my case, insurance pays for EI so I don't have the "rules." LA gets EI and private therapies. I just have to make sure I keep track of my visit allowances.

Florak8 · September 2011

In my county EI provides no therapies other than "consult as needed". So we do all private, except for pop-in services at DS' day-care.

I would think you would be able to find the answer to this on your EI website. Seems shady, but might be true.

MaxandRuby · September 2011

I have no idea why you can't get insurance covered therapy and EI services at the same time. That makes no sense and shouldn't have a baring on one or the other IMO but maybe it is a specific state thing. I suppose you wouldn't have to tell them about the insurance covered stuff????

FWIW, DS2 has had EI and private covered therapies in 2 different states so far with NO issue (this would be IA and KS). We just moved to TN and I am in the process of getting the same types of services out here for him.

BUmama · September 2011

That doesn't seem right to me, but I would call the EI office and the private provider and ask them both.

I know that our insurance did not cover EI so we sought private services that were covered and she now gets school based services as well as the private.

virginiamorse · September 2011

I've never heard of that before but EI does vary so much by state I guess it could be true. When we lived in Michigan DS received EI (which was free, not paid for by insurance) and private (which we paid for oop). Now we're in Illinois and DD is receiving EI which they do bill our insurance, so I guess I could see how we wouldn't be able to do private too.

As for which is better that totally depends on the service providers. Our EI in Michigan sucked, really poor services, poorly trained staff (not even real therapists). Which was why we paid oop for private. Our EI in Illinois is very good, contracted out to a good center (that also sees kids privately) and an actual real therapist.

jsugrin · September 2011

Seems very odd to me. We did speech both through our insurance and EI. In fact our EI team coordinated everything with the insurance and even paid our $10 per visit co-pay so we had no cost on our insurance part either. In our case the ST recommended twice a week therapy but EI could only provide once a week because of budget stuff so our insurance picked up the 2nd weekly visit. I guess I could see a situation where EI had recommended 1 weekly visit and if they were covering it and then you were also getting the same service via your insurance that EI would refuse to provide the service since you were receiving what they recommended through your insurance, does that make sense?

LandoWedding · September 2011

Seems odd.

There may be restrictions, but more like this:

In Virginia, EI charges your insurance. Then, what insurance doesn't cover, you pay on a sliding scale. Most insurance only covers so many sessions per year, so if you went over that, you couldn't get both.

Call your case manager!! (And call your insurance.)

st.augbride · September 2011

We used both EI and private services for a bit. Our EI PT at first was on board, but then seemed to get defensive about it. For us, the quality of the private services was so much higher that we just stopped EI and doubled up on private.

birdie_1010 · September 2011

Huh, I have never heard of that before. My younger son gets 2 hours per week of services through the birth to 3 EI program and does 8 hours per week of private pay services. Our EI program actually encourages us to seek outside therapy services since their reach is only so far. In addition, they do their best to work with our outside therapists and have them attend all IFSP meetings to make sure we are all on the same page.

FutureMECC · September 2011

In CO that is the case. We can not take DD to a private ST and get an EI ST in home. Same with PT and OT.

OSULori · September 2011

I feel like in OH it differs by county...I did my last SLP clinical doing homebased EI in a county in SW Ohio and I remember my supervisor telling me that if she had a client that got picked up for private therapy she was no longer able to see them. But as an SLP in a clinic setting now, I'm pretty sure I have little ones who get private therapy and homebased EI.

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