Everything is so expensive!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

On your taxes that is.

You can only deduct it if it reaches a really high amount in total and you itemize. Not many people get there.

This. You would need to itemize instead of taking the standard deduction and then the amount being deducted is for unreimbursed expenses over 7.5% of your AGI. For example, if your AGI is $270K you would only be able to deduct unreimbursed expenses exceeding $20,250.


It’s worth doing projections based on current expenses to get a sense of whether you should track.

[Anonymous]

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home.

[Anonymous]

Anonymous wrote:OP here and so far we have done everything out of pocket through providers who don’t submit to insurance. Her pediatrician was useless when we shared the issues DD is having so we got a recommendation from her school for a provider to do a neuropsych and paid out of pocket.

It’s hard but find OTs and therapists covered by your insurance. It took some time and we had to drive a little farther, but we ended up paying a fraction of what we were paying out-of-pocket. It is absolutely worth it.

[Anonymous]

Be selective and focus on interventions that you think is most helpful. In our situation, medication, tutoring and an IEP made the biggest difference. We eliminated everything else. Everything else we did was a money pit. It was financially and logistically unsustainable.

Now that DC is older and more mature (high school), therapy may help so we are on a waiting list for a therapist that takes insurance.

[Anonymous]

OP here and I agree with the neuropsych that DD needs all these services - we are not being scammed (and actually I found her testing to be worth every penny). I don’t imagine this will be forever but she needs it now. And yes she enjoys her childhood and actually she does swimming, dance and music.

Thanks for folks with helpful tips on how to deal with the expenses. Agree that if some services are not helping we will not do them - especially as the school year starts we will likely need to drop down on these services and focus on the ones making the biggest difference.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home.

Can you provide more info on the disfluency issue? Speech was recommended for my AuDHD child who struggles with this as well. For her it's almost like an apraxia, where the processing speed and motor planning to express herself combine to add up to disfluency.

[Anonymous]

We saved money by doing much of the tutoring and therapy ourselves - and when I say us, I mean mostly me

My child was born premature with a global developmental delay, which were then refined into a speech delay, severe ADHD, mild ASD, dysgraphia and gross and fine motor tone/coordination issues.

Until he was 3, his PT, OT and speech was free and administered by Montgomery County ChildFind. We paid for private speech from 3 until K, and then his IEP at school gave him hours with the school SLP, who was great.

I observed all his toddler/preschooler sessions and replicated them intensively every day so he could improve faster. The ChildFind therapists gave us a lot of items to work with. Once he was out of PT and OT, I enrolled him in regular gym, ballet and swimming, and worked with him on handwriting and fine motor skills at home. I also tutored him academically every day in elementary.

For secondary school, we paid for a writing tutor. My husband took over the math and science tutoring, until he got to AP exams and ACT test prep, which we paid for.

He needed an executive function coach day in, day out, so hiring one was out of the question. We were his executive coaches.

Point is: pace yourself, OP. Our kid had serious needs, and we knew we had do a lot of the work ourselves, for as long as we could, to make it work financially.

[Anonymous]

Anonymous wrote:We saved money by doing much of the tutoring and therapy ourselves - and when I say us, I mean mostly me

My child was born premature with a global developmental delay, which were then refined into a speech delay, severe ADHD, mild ASD, dysgraphia and gross and fine motor tone/coordination issues.

Until he was 3, his PT, OT and speech was free and administered by Montgomery County ChildFind. We paid for private speech from 3 until K, and then his IEP at school gave him hours with the school SLP, who was great.

I observed all his toddler/preschooler sessions and replicated them intensively every day so he could improve faster. The ChildFind therapists gave us a lot of items to work with. Once he was out of PT and OT, I enrolled him in regular gym, ballet and swimming, and worked with him on handwriting and fine motor skills at home. I also tutored him academically every day in elementary.

For secondary school, we paid for a writing tutor. My husband took over the math and science tutoring, until he got to AP exams and ACT test prep, which we paid for.

He needed an executive function coach day in, day out, so hiring one was out of the question. We were his executive coaches.

Point is: pace yourself, OP. Our kid had serious needs, and we knew we had do a lot of the work ourselves, for as long as we could, to make it work financially.

Me again. None of the stuff we paid for was reimbursed. The psychiatrist we used wasn't too expensive - $180 per session, but after the medication ramp-up period, we didn't see her often, and when he stabilized on one med, the pediatrician took over the prescribing.

[Anonymous]

Anonymous wrote:I always get blasted on here when I point out that everyone is out for SN parents’ money and that you need to be very discerning about what you throw money at.

Just because someone did testing and said your child has all of these conditions does not mean they all need therapy or the type of therapy suggested or all the therapy at the same time.

Nothing can substitute for you yourself knowing your child and identifying the key challenges that need support right now.

If she is in K and struggling with reading and writing, then you need OT and a strong IEP with pullouts.

If she is in MS and not completing homework, then more structure and routine.

If she has anxiety affecting her daily, then evidence-based therapy like SPACE.

and so on.

This is absolutely true and it took me a while to realize it. SN services are a business just like anything else. We only see in-network providers, get as much therapy at school as possible, look for funding sources, and take advantage of free rec programs. I hate thinking of my kid as somebody's charity but he is expensive and we will be saving to pay for the rest of his life so no fancy retirement plans for us.

[Anonymous]

Anonymous wrote:OP here and I agree with the neuropsych that DD needs all these services - we are not being scammed (and actually I found her testing to be worth every penny). I don’t imagine this will be forever but she needs it now. And yes she enjoys her childhood and actually she does swimming, dance and music.

Thanks for folks with helpful tips on how to deal with the expenses. Agree that if some services are not helping we will not do them - especially as the school year starts we will likely need to drop down on these services and focus on the ones making the biggest difference.

I’m just going to push back a little and ask how you are so sure she needs all of the services now? Doesn’t she get anything in school?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home.

Can you provide more info on the disfluency issue? Speech was recommended for my AuDHD child who struggles with this as well. For her it's almost like an apraxia, where the processing speed and motor planning to express herself combine to add up to disfluency.

DP, but wanted to share that that our child had intensive speech therapy from 2.5-5 years old (totaling 4 hours a week). Motor planning and processing issues = apraxia = disfluency, for our kid. It was worth every penny and now they have zero speech issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home.

Can you provide more info on the disfluency issue? Speech was recommended for my AuDHD child who struggles with this as well. For her it's almost like an apraxia, where the processing speed and motor planning to express herself combine to add up to disfluency.

DP, but wanted to share that that our child had intensive speech therapy from 2.5-5 years old (totaling 4 hours a week). Motor planning and processing issues = apraxia = disfluency, for our kid. It was worth every penny and now they have zero speech issues.

Do you mind sharing the name of your SLP?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home.

Can you provide more info on the disfluency issue? Speech was recommended for my AuDHD child who struggles with this as well. For her it's almost like an apraxia, where the processing speed and motor planning to express herself combine to add up to disfluency.

DP, but wanted to share that that our child had intensive speech therapy from 2.5-5 years old (totaling 4 hours a week). Motor planning and processing issues = apraxia = disfluency, for our kid. It was worth every penny and now they have zero speech issues.

Do you mind sharing the name of your SLP?

I’m not the same poster but DS had the same diagnosis and also did intensive speech for apraxia. We used Stacy Fleischman. I’m not sure if she is still seeing patients but she was fantastic. I give her a ton of credit for our son’s outcome. In the years after he left speech, nobody believed he had apraxia.

[Anonymous]

Anonymous wrote:OP here and so far we have done everything out of pocket through providers who don’t submit to insurance. Her pediatrician was useless when we shared the issues DD is having so we got a recommendation from her school for a provider to do a neuropsych and paid out of pocket.

You get a superbill from the provider and submitted it to insurance. At least it will add up towards your deductible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent. For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses.

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home.

Can you provide more info on the disfluency issue? Speech was recommended for my AuDHD child who struggles with this as well. For her it's almost like an apraxia, where the processing speed and motor planning to express herself combine to add up to disfluency.

DP, but wanted to share that that our child had intensive speech therapy from 2.5-5 years old (totaling 4 hours a week). Motor planning and processing issues = apraxia = disfluency, for our kid. It was worth every penny and now they have zero speech issues.

Do you mind sharing the name of your SLP?

Unfortunately, we weren’t in this area.