Insurance Is Refusing to Pay for My Son's Speech Therapy

I know that speech therapy is very hard to get insurance companies to pay for, especialy for an extended period of time. I went trough this with my son. I ended up having to call te insurance company and find out ow to do an appeal. If I remember correctly, both his pediatrician and therapists had to write letters as to why this is beneficial. I also wrote a letter stating why I thought it was beneficial. It needs to be as specific as possible...
Good Luck
J.

I don't now about Ohio. In Indiana, we have a state-funded program that provides therapy until age 3 and then you go through the school systems. Have you checked in to what public options you have?

I have been through problems in the past with Insurance companies denying claims. Contact the "Department of Insurance" with your state. If you are in Ohio here is a link:
http://www.insurance.ohio.gov/Pages/default.aspx

The phone number is 1-800-686-1526
Hope this helps,
C.

I completely understand what you are going through! I have a son who has been in speech therapy for one year now. My insurance said from the beginning they would not pay for any speech therapy. He also doesn't have anything wrong other than speech. After looking around at different agencies and private speech tutors...someone finally told me what every parent should know. Once your child turns three years old, they are a part of the school system in which they live. Which for me means, free speech therapy! The speech teacher at the local elementary school sees him once a week at a designated time set up by both me and her. I'm not sure where you live, but you should definitely look into this. I want to remind you that I pay NOTHING! If you have any questions please send me a message and I will help you out with all information you need, to include the speech teacher that I use.
M.

Have you exceeded your visits for the year? We get 20 speech, 20 PT, 20 OT and there are no exceptions. Maybe that is how yours works? I would definitely look into it further. I hope that you can figure something out.

Not sure where you are located but we some therapy centers let student therapists work out their internships and they offer it free to kids that run out of sessions. Call around. Good luck!

Good luck to you. It will be a long road, and I don't know who to recommend, but you can also have him identified through your local school district too. You will always need to have private therapy too, but you may qualify for some of it to be covered at school starting at age 3, especially since his delay is sever.

One caution, if you have not had the developmental aspect ruled out by a Developmental Pediatrician (found at children's hospitals-NOT regular pediatricians) then to be safe, I would do so. You do not want to find that your information was wrong when he is too much older, early intervention is best.

If your insurance is through a "self insured" work place, you may have more of a battle than if not. Self insured companies pay insurance companies to administer the insurance only. These companies have a loophole for some insurance regulations and will rarely if ever cover speech, or related services. The Senate is dealing with insurance discrimination for Autism right now and has put some language in the health care reform act, but it is unclear to me if the self insured loophole is closed by this, and no one knows if it will ever pass.

Good luck, keep fighting, but always pay for the service he needs so that he makes the kind of progress you want to see.

M.

K.

Contact your local public school. In Ohio the school district is responsible at age 3 to provide services the children with disabilitites... Good Luck!

Have you had your son evaluated by the local school district for preschool?? He may qualify for special needs for speech.

Has your speech therapist submitted progress reports to show what he has accomplished?

When I called our insurance company about OT for our son, they would pay with progress for 60 days then would require a re=evaluation to be submitted. We ended up getting him covered by Franklin County MRDD for his OT therapy and haven't had to fight it with insurance. Plus he gets therapy at SWCS preschool.

Just a thought! Good Luck!

My first question was: What happened after the first two months that they paid to make them not pay? Did the billing/coding change? Something had to have changed for them to change their minds about it.

Make sure that when the bills are sent in, that ALL the codes that are applicable are included, not just one or another, but all the ones that apply need to be on there.

Are you sure you haven't reached a limit in the insurance coverage? (That they'll pay only to a certain point?) Have you asked them to review the claims?

Is it through First Steps? If not, call them and ask if they can help at all in giving you some direction on how to proceed.

Just a few thoughts...good luck!

Does your policy limit the visits (eg. 20 visits) or does it state for a period of time? My son was covered for one year and then they had (the provider) had to prove some medical question which I can't remember now, maybe he reached a plateau I'm not sure. I worked with a case manager at the insurance company and it made it easier with getting bills taken care of. Obviously you need to talk to your insurance company and someone higher up than an insurance claims rep. Consider if this a long term condition having the company assign you a case manager. You also need to talk to your benefits administrator at your employer and go over it with them. With my son they approved some things for us because the language was ambiguous and sometimes unexpected things crop up. As someone else has said you should have your child evaluated by your school district. My son had a multifaceted evaluation done by the school psychologist and that made him eligible for speech and language therapy in the district. (free) Since we had a preschool he was enrolled for no fee in their program.

How old is your son? The state is legally responsible to pay for all speech therapy once a child turns 3. Before age 3, contact First Steps for free/inexpensive therapy services. The evaluation (for both programs) is free. If he is at least 3 years old then he'd have therapy either at the local elementary school or a stand-alone building the school uses for other children with disabilities. Our son had speech therapy from age 3 through the end of kindergarten and we never paid a dime. He was actually 'caught up' and done the May before kindergarten started but they continued another year to make sure he didn't backslide and retained everything.

I don't know anyone who had speech therapy covered by insurrance. Most insurrance policies don't cover anything related to developmental delays - it how they get out of paying for treatment related to austim/asperger's (as we're finding out first hand!).

Just call your local elementary school and ask for contact info regarding the Early Childhood Development program.

Sorry that you are having problems with your insurance company. A lot of people that I know are having this problem paying for speech therapy for their child when the child obviously needs speech therapy. It irritates me that the insurance companies are doing this to families. Good luck!

K.,

I would continue to fight for coverage through your insurance. They try to get out of paying as much as they can and count on people not continuing to pursue it. Keep asking for someone higher. They need to spell it out clearly if they at all mention speech therapy as a covered service. Ask the speech therapist to help you. Document names/dates/responses and keep a log of all interactions with the insurance company.

Services are provided through the school system in your area (I live not far from there). Contact the educational service center in your county (in the phone book or online). You can also contact the local elementary school and they can direct you to the ESC. Your child would be evaluated (there is likely a wait as it is very busy at the start of the school year)and should qualify if he has a severe speech impairment. Often services at the preschool age are provided in a preschool class setting. They may suggest your child goes to a preschool class where they have early childhood teachers specializing in special needs or maybe a regular preschool class. Sometimes services are within the class and other times the child is taken aside. They may have a private session at a building but that doesn't seem as frequent anymore. It sounds like what your child is receiving now is individual therapy at a center or other setting. Private therapy like that is a little less distracting and may be more frequent than through the schools. He may be able to do both if you can get the insurance company to pay. If so, make sure you share info between the therapists so they can work together rather than completely separately.

I hope things work out well. Send me a message if you need help finding what you need.

K.