Anyone getting priced out of intervention?

[Anonymous]

We have 3 children. All need speech and 2 need OT. We recently made the difficult decision to take a break from speech for the oldest 2 (ages 6 and 8) because they're receiving therapy in school and are mild at this point. This has allowed us to pay for 2x weekly hour sessions with an SLP for our youngest (age 2 1/2). We hope to start back up with speech for the big kids in January. As for OT, our 6 year old has a very significant fine motor delay so we must pay for his therapy, but we did make a decision to cut back from 2x to 1x a week so that our little guy could go 1x a week. We are lucky to have good insurance that covers 80% but those fees sure do add up quickly. On top of it, our providers don't bill insurance so we have to submit which means we always need an extra $2000 a month in our account to cover expenses while we await reimbursement. MoCo infants and toddlers has been terrible about addressing our 2 yr old's needs which seem to grow more complex by the day. MCPS provides only minimal services and in a group setting. For our little guy, we have no diagnosis and thus, no prognosis. This means we can't reassure ourselves that this is a temporary situation. We spend more money each month than we bring in and we can't help but wonder what will happen when the savings run out. Still, we have no choice.

[Anonymous]

So sorry for the parents who are getting priced out. That must be so challenging for you. I hope that you are able to work with a therapist to give you a "playbook" so to speak so you can continue therapy at home. That is actually one of the reasons why I am going to sit in on as much of the therapy sessions as possible. I want to absorb what they are doing so i can engage in creative play - and also see what my child is capable of doing. So, for parents who think they are going to be priced out of therapy - make sure you sit in on as many of the therapy sessions as possible. You might not learn to be a therapist, but you can probably copy some of the techniques they have tailored for your child.

Good luck.

[Anonymous]

Are there really insurance plans that cover OT and Speech. My insurance (Aetna) excludes anything related to a developmental delay and autism, and I assumed that all insurance plans did the same.

[Anonymous]

We have the Federal Employee's Blue Cross/Shield standard plan and it has consistently paid for OT, Speech, and psychologist visits. We bill using hypotonia and apraxia codes and PDD codes for the psych visits. We can't bill under development delay, though.

[Anonymous]

This is a great juncture to point out that there is a biiig divide between what the Feds get in their insurance and what the rest of us get. Collective bargaining and all.

I have regular old NOT Federal Employee's BC/BS and it covers not a single cent for any OT or ST. (unless the insured is in a bad accident or something.)

That was also true when we had Aetna like 10:44.

I used to be a Fed and now I'm not and the difference in coverage is stark, esp. for all those things that are not hit-you-over-the-head emergencies.

[Anonymous]

The Fed insurance is not quite how the PP described. First off it is a complete PITA to get them to pay for ST. Second, you have a deductible to go through before they pay a dime for therapies outside network, but those sessions still go toward your alloted sessions. You cap off fast if your kids get multiple interventions and the rest is out of pocket. Yes, it's a good insurance, but we pay a lot for it and the amount is going up. Unless the PP is a member of congress I doubt the coverage is as good as implied.

[Anonymous]

Yes, the caps and deductibles do apply. Sorry if I neglected to mention that. The 75 per limit cap on a combination of PT, OT, and Speech is decent, in my opinion.

I used two different speech providers (in network) and never had any trouble getting it paid. No extra paperwork, appeals, etc. My OT was out-of-network. I am just a run-of-the mill federal agency employee.

[Anonymous]

This thread saddens me.
We are just realizing the fact that our DS will need speech and OT as soon as possible, so as not to fall behind when he enters first grade. We could not afford to with Aetna, but now we have BCBS HMO, I saw the first 30 or so sessions are covered - we will only pay $40 for each!

I too, was planning on "learning the ropes" and implementing key techniques at home.

Good luck to all!

[Anonymous]

If I wasn't so damn tired I'd pimp myself out.

[Anonymous]

To 15:05...ohhhhhh your ST is in network. That makes a HUGE difference! Out of network is a whole different story with ST. For some reason it is easy with OON OT, but not ST. Where did you find an in-network ST?

You know even our co-pays are going up right? Am curious to see if reimbursements go down.

[Anonymous]

We don't have federal govt insurance but we are lucky that ours covers speech and OT. They're awesome about OT but they make speech a pain. You have to prove that it's medical and they only approve 3 months at a time. It's a lot of work to stay on top of the authorizations but I'm grateful we have the coverage. I can't imagine where my kids would be without it.

I agree that it's a good idea to watch what the therapists are doing so you can supplement at home. I try to use similar techniques between sessions and it's very helpful. I've even purchased some of the toys our OT uses so my son can get extra practice.

[Anonymous]

The ONLY insurance that we discovered will help us with therapiest is BCBS PPO. He had HMO, and they kept a chain on everything we did. The trouble is the therapists that are best suited to meet our child's needs do not accept insurance. I can count on one hand the PT, OT, SLP practioners in MoCo anyway that accpet full insurance payments. Out of these, you have to find one that has extensive experience and training to treat your child's particular need. (for ex, our child needs OT for motor delays, NOT sensory processing) I will not name practices, but the practices that are 'in network' for our plan, are not practices I trust in treating my child. Not that they are not trustworthy (well, one I do not trust) but they do not have experience in treating my child's challenges.

SOMETHING has to change for all of us. And we can't blame the therapists, as most have opted out bc of the bull that the insurance cos have put them through in the past.

[Anonymous]

Uh-oh, 16:08.
I am the PP with a new BCBS HMO, about to jump in and search for therapists.

Could you explain how your old HMO "kept a chain" on everything you did?

Thank you!

[Anonymous]

I don't blame the therapists for opting out of insurance. I accept that I have to be the one to do the paperwork. I do blame them for choosing to do a 10% increase in fees during hard times. I plan to investigate if their rent with up and if it didn't or if it went up very little, there is no excuse. I would have been annoyed with a 2-3% increase and even a 5%, but we would have found a way to manage, but 10%??!!! We aren't getting raises, cost of living is going way up (groceries, etc). Oh and we are paying A LOT. It's not like we were paying less than the going rate before.

[Anonymous]

Anonymous wrote:Uh-oh, 16:08.
I am the PP with a new BCBS HMO, about to jump in and search for therapists.

In our experience, few therapists are willing to accept HMO, many more will work with PPOs. Our HMO required us to seek their preauthorization/approval prior to any therapy, and limited number of sessions. When we changed to PPO, all of those requirements went away, and more therapists/physicians accepted PPO. Whenever I'd call a new practice, the first thing they'd ask is whether it is an HMO or PPO.

If your dc requires more than one therapy per week, I'd strongly suggest you consider a PPO, if at all available to you.

Could you explain how your old HMO "kept a chain" on everything you did?

Thank you!