Community› The Bump Message Boards› Special Needs
Special Needs
New Discussion

Insurance frustration

ckmommyckmommy member
in Special Needs
I received a call yesterday from the insurance verification worker for the therapy center we are using. C has been denied speech therapy because he does not have Autism. Apparently the only way it is covered on our plan is with an ASD dx. I had no idea nor did my husband. We didn't really choose a plan, we only had the one option. We applied for Medicaid to see if we could get secondary coverage but I have no idea if that will work. Is there anything else I should be trying? We plan to appeal the decision but I don't know if I should be doing more.
Baby Birthday Ticker Ticker
Report Reply to Post

Re: Insurance frustration

  • kar5162kar5162 member

    That's super frustrating. There's been a lot of activity in WA recently about pushing to modify insurance to treat neurodev delays like autism and other things since, school therapy is frequently (very) insufficient. I don't know of any special programs for free/reduced cost coverage aside from if you can qualify income wise for Medicaid. Aside from pushing your insurance company or looking for positions with better coverage, not sure if there are other options.

    https://seattletimes.com/html/localnews/2019705690_autismlimits18m.html

    Report Reply
  • Loading the player...
  • realisticdreamsrealisticdreams member
    Our current plan only covers therapy for 'restorative purposes.'  Like, if you had a stroke and needed help learning to speak again, etc.
    It sucks & we had no idea!  
    Have you been in contact with Early Intervention?  Our early intervention won't even give dd2 (who is now 2) a speech therapist, just a developmental therapist, I'm sure I could fight for it, but she really needs a medical model, which isn't covered :-
    You could see if the therapy center itself had a financial assistance policy that may be based on income.  Medicaid is different in every state, but generally this would be covered under a medicaid waiver, if your child has certain diagnosis.
    Good luck..(insurance does suck! I'm looking at a $14,000 bill from my tubal/leep in December!)
    DD1(4):VSD & PFO (Closed!), Prenatal stroke, Mild CP, Delayed pyloric opening/reflux, Brachycephaly & Plagiocephaly, Sacral lipoma, Tethered spinal cord, Compound heterozygous MTHFR, Neurogenic bladder, Urinary retention & dyssynergia, incomplete emptying, enlarged Bladder with Poor Muscle Tone, EDS-Type 3. Mito-Disorder has been mentioned

    DD2(2.5): Late term premie due to PTL, low fluid & IUGR, Reflux, delayed visual maturation, compound heteroygous MTHFR, PFAPA, Bilateral kidney reflux, Transient hypogammaglobulinemia, EDS-Type 3


    Report Reply
  • amajaneamajane member

    We are in WA and also are seeing coverage for therapies being limited. My policy thru work (Cigna) only covers 30 visits per year of any therapy. Total. It sucks. 

    But we got an Autism diagnosis last year so we could get more services and have been approved for 25 hours per week of behavioral therapy! That's great but my child doesn't walk or talk so she really needs additional speech therapy and physical therapy. You'd think the insurance companies would get that.

    Perhaps you should look into getting an Autism diagnosis? We went to Lakeside Center for Autism in Issaquah and they were awesome.

    We don't qualify for Medicaid because we make too much money. Our daughter is enrolled in DDD but we don't receive any benefits for that. 

    Let me know if you if the insurance accepts your appeal. 

    Warning No formatter is installed for the format bbhtml
    Report Reply
  • ckmommyckmommy member
    We have Cigna too. It is horrible.
    Baby Birthday Ticker Ticker
    Report Reply
This discussion has been closed.
Choose Another Board
Search Boards
"
"