How to get insurance company to cover more of the speech therapy fee?

[Anonymous]

Anonymous wrote:

Anonymous wrote:What about an IEP? Students sometimes get speech therapy in their classroom, through the public school.

Np -- her dc probably has an IEP but therapy in the school is in a group, not one on one and is so different from private. A lot of kids with a diagnosis like MERLD truly need the one on one assistance of a private speech therapist. It is a shame that so many in the DC area are out of network. I moved to another state and assumed it was the same way and told a place that I would pay for a social skills group. They said, you're uninsured? in a sad voice. I, of course, was shocked to find out that they took my insurance. I laughed and explained that I was coming from a place where every provider was out of pocket. It's a shame that people can't get the care they need with insurance they pay for.

It's a shame that the insurance companies won't pay the providers a decent amount.

My DC 'graduated' from speech a few years ago. At the time my DC's SLP participated with insurance and set her rate at $110 an hour; Carefirst would only pay $60/hour and we had a $15 copay. Eventually the SLP stopped accepting insurance because she couldn't make a living and cover overhead in this area.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What about an IEP? Students sometimes get speech therapy in their classroom, through the public school.

Np -- her dc probably has an IEP but therapy in the school is in a group, not one on one and is so different from private. A lot of kids with a diagnosis like MERLD truly need the one on one assistance of a private speech therapist. It is a shame that so many in the DC area are out of network. I moved to another state and assumed it was the same way and told a place that I would pay for a social skills group. They said, you're uninsured? in a sad voice. I, of course, was shocked to find out that they took my insurance. I laughed and explained that I was coming from a place where every provider was out of pocket. It's a shame that people can't get the care they need with insurance they pay for.

OP here, Yes, DC has an IEP but receives group therapy. MERLD really needs one on one therapy

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What about an IEP? Students sometimes get speech therapy in their classroom, through the public school.

Np -- her dc probably has an IEP but therapy in the school is in a group, not one on one and is so different from private. A lot of kids with a diagnosis like MERLD truly need the one on one assistance of a private speech therapist. It is a shame that so many in the DC area are out of network. I moved to another state and assumed it was the same way and told a place that I would pay for a social skills group. They said, you're uninsured? in a sad voice. I, of course, was shocked to find out that they took my insurance. I laughed and explained that I was coming from a place where every provider was out of pocket. It's a shame that people can't get the care they need with insurance they pay for.

It's a shame that the insurance companies won't pay the providers a decent amount.

My DC 'graduated' from speech a few years ago. At the time my DC's SLP participated with insurance and set her rate at $110 an hour; Carefirst would only pay $60/hour and we had a $15 copay. Eventually the SLP stopped accepting insurance because she couldn't make a living and cover overhead in this area.

That's a really sad reality for most SLPs and it's extremely expensive for us

[Anonymous]

The group school speech is worthless my child gets. It isn't even catered to his needs.

I would try one of the University programs - MD, Loyola of MD in Columbia, GW (or is it Georgetown).

Most insurance companies or at least ours only pay for a time slot, not by the length of time for the session so our SLP will only give us 30 minutes too. We had a lot of trouble getting it covered and we private paid for a long time. We finally found a doctor who knew the system who could get us an exception to the provider as they were partially in-network by claiming it was a preexisting relationship and distance was too far for other providers or the providers could not meet my child's needs that we tried.

[Anonymous]

I argued for Aetna to cover our speech therapy with an outside provider because I was able to document that my son a) had a medical need for therapy (which should be covered) and b) there were no available in-network providers. I proved that the "dozens" of providers on their list were duplicates listed at multiple offices, and that here were really only two in-network providers - one was Georgetown Hospital and one was Children's and both had a wait time of 12-18 months. This was very stressful and time consuming but with support from my SLP and pediatrician and ENT and a lot of patience I got them to cover the weekly speech with a private provider for just the copay $30 for two years until he was discharged.

[Anonymous]

I don't know where you're located, OP, but my child does speech therapy at Pediatric Development Center on Prosperity Drive in Silver Spring. They have a second location on Redland Drive in Rockville. We have a UHC-network federal plan, so they will only give us 30-minute sessions in-network, but I remember them telling me they do 60-minute sessions for BCBS. It might be worth asking them. Their website is www.pdcandme.com

[Anonymous]

We have BCBS and only paid a copay for speech.

[Anonymous]

Anonymous wrote:What about an IEP? Students sometimes get speech therapy in their classroom, through the public school.

Another major limitation of the IEP therapy is that it follows the school schedule with rare exceptions. So no speech during the summer, over holidays, etc.

[Anonymous]

This is all very helpful. Thank you. I'll try the exception clause, only covering the co-pay would be worth it.

Did you have to use a developmental pediatrician for the medical necessity? or your regular ped was enough plus the SLP's evaluation?