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Switching to Kaiser - help

CelynCelyn member
in Northern California Babies

We've finally said no to the new rate hikes on our Blue Cross insurance.  We're paying out of pocket for everything we do for Ryan anyway, since it was out of our network, so we opted to spend $600 a month less for the "insuring" part and switch to Kaiser.  I don't know anything about their system though. 

Does anyone know if Kaiser offers OT for kids on the spectrum, speech, and/or Theory of Mind in house?  If they do don't, what happens if you have to go to a private specialist?  Do they cover it?

If you have a kid on the spectrum, and don't already know this: Next year all insurances will be required to cover ABA (applied behavior analysis).  How awesome is that?  We've paid thousands out of pocket for it up to this point. 

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Harmony Doula
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Re: Switching to Kaiser - help

  • love22love22
    I know when we go M tested for speech we were denied services (which is what we were looking for) because they only offer rehabilitative speech therapy (i.e. if you lose the ability to speak in an accident).  We receive our services currently through the regional center and if he qualifies when he turns 3 he'll receive services through our school district.
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  • amyfeliceamyfelice
    We are switching too. I am so sick of Blue Cross trying to avoid covering everything. 
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  • jsugrinjsugrin member
    Do you have any links to the ABA info?  I'd love to read more about how that's going to work.  Do you know if self funded plans will be exempt or if it's a literal "all" plans?.
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  • CelynCelyn member
    This is what I know: https://www.autismvotes.org/site/apps/nlnet/content2.aspx?c=frKNI3PCImE&b=3930723&ct=11282473
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    Harmony Doula
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  • kittylovekittylove member

    99% of Kaiser's plans don't cover *** when it comes to theray for ASD, speech delays and such. When DH got this job we looked at what Kaiser was offering as well but while it was zero copays for almost everything and 25 dollar ER visits (it even had IF coverage!) but not a single therapy was going to be covered.  I am really excited for the ABA coverage! It wont effect us but it is still really great.

    With Kaiser if you chose to do any OT speech or ABA (at least till next yr) you pay 100% out of pocket.

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  • futrkingsleyfutrkingsley member

    We had C tested through Kaiser for a speech delay and eating issues.  They were great when we met with them -- he saw a Dev. Pedi, an OT for the eating, and a SLP for the speech. He also had his hearing evaluated at their audiology lab.  All evaluated him and agreed it was isolated to a speech delay and that our coverage did not provide benefits for that unless the delay was caused by a physical issue (tongue tie, hearing issue or low tone maybe).  We got services through EI instead.

    I am not sure how the "treat" autism or other spectrum disorders.  I know that years ago KP was sued for not providing benefits for autism treatments (their reason was the same one given for not treating speech), but I don't know what the outcome was.  I know they have a full staff of therapists -- speech, OT, behavior therapist -- the department at our local KP is big and the back office is a maze of therapy rooms with all sorts of equipment.  So someone is getting therapy there but I don't know what it's for.

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