Paying out of pocket for doctors

[Anonymous]

Is it fairly common to have to pay out of pocket for specialists for kids with special needs? We are new to the special needs world and have been shocked to find out that none of the recommended doctors are in network and that they charge upwards of $300/hour.

And, I just read the financial mistakes thread where someone felt that paying thousands in therapies for their child with special needs was a huge waste.

I am afraid that I am being foolish in shelling out these large sums. I don't want to be taken advantage of. But I want to get my child the necessary help.

Oh, this is so confusing.

[Anonymous]

Yes. A lot of the better providers do not accept insurance. (Especially in the mental health world- child psychologists and psychiatrists). Or they accept insurance but your insurance doesn't cover it for the reasons you need it (speech therapy).

The ones who are in network for insurance often have very long wait lists.

It is shocking.

[Anonymous]

My child was recently diagnosed with a disability as well, and I have found this to be true. I don't see a way around it as far as private therapies go. I have my child in a social skills group that is costing a shocking amount per month with no end in sight! There is also OT that we go to with out-of-network benefits. We pay 40% for every visit.

[Anonymous]

Four words: High Deductible Health Plan.

[Anonymous]

Welcome to the world of special needs parenting! Yes, the vast majority of therapists and doctors do not take insurance and are very expensive, but you don't really have a choice so you just do it.

[Anonymous]

Thank you so much for your replies. While I am very sorry that you all have had to do this, at least I know that I am not being played for a fool. I think this may be a DC/big city thing? My friend in a much smaller city was shocked that the recommended doctors did not take insurance.

[Anonymous]

Just to say that there ARE exceptions: my child needed eye surgery, and the surgery was covered by insurance, but not with the doctor (Paul Gavaris) that we wanted. Dr. Gavaris performed the surgery, which went well (thank God); insurance covered about 75 percent of it, and the doctor waived the rest of the fee.
I will see what happens with Stixrud--their $3200 for initial eval is on my credit card, burying me in interest.

[Anonymous]

Anonymous wrote:My child was recently diagnosed with a disability as well, and I have found this to be true. I don't see a way around it as far as private therapies go. I have my child in a social skills group that is costing a shocking amount per month with no end in sight! There is also OT that we go to with out-of-network benefits. We pay 40% for every visit.

Oh no! What social skills group? Those were a huge waste for us. We didn't have a hard time finding in network OTs though.
We usually just had a $30 copay for the OT.

Psychologist another huge money suck for us. $165 per visit, once a week, indefinitely? And I just can't tell if it's doing anything useful.

[Anonymous]

We have had good luck getting out of network reimbursement for psychologist and psychiatrist visits.

Unless my DD is in a crisis, we generally only do visits to the therapist every 2-4 weeks. That helps too.

We found social skills classes to help, but I can see where they wouldn't benefit every kid.

[Anonymous]

We had great success with DC's social skills group and it was $65-$75 per week and insurance covered some of it (OON). It was a place where he could go where people wanted to see him and where he developed relationships that he couldn't in school. Change happened, but it did not happen over night. The monthly parent group also helped immensely. DC is on the mild end of the autism spectrum.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My child was recently diagnosed with a disability as well, and I have found this to be true. I don't see a way around it as far as private therapies go. I have my child in a social skills group that is costing a shocking amount per month with no end in sight! There is also OT that we go to with out-of-network benefits. We pay 40% for every visit.

Oh no! What social skills group? Those were a huge waste for us. We didn't have a hard time finding in network OTs though.
We usually just had a $30 copay for the OT.

Psychologist another huge money suck for us. $165 per visit, once a week, indefinitely? And I just can't tell if it's doing anything useful.

I really don't mean to be rude, but: Why continue?

[Anonymous]

All of our specialist are out of pocket and then at the beginning of each month I submit the previous months claims. This is for OT, Speech and ABA.

[Anonymous]

Our OT is in network and we pay a $12 copay/visit. That being said, I do have to drive 45 miles (miles, not minutes) one way, but there has been a lot of improvement, so it's worth it to us. I would pay out of pocket, if I had to because our child has benefited from it - if he showed no improvement, I would stop.

I have talked to other parents in the waiting room and they pay out of pocket and I think the hour-long sessions are $120.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My child was recently diagnosed with a disability as well, and I have found this to be true. I don't see a way around it as far as private therapies go. I have my child in a social skills group that is costing a shocking amount per month with no end in sight! There is also OT that we go to with out-of-network benefits. We pay 40% for every visit.

Oh no! What social skills group? Those were a huge waste for us. We didn't have a hard time finding in network OTs though.
We usually just had a $30 copay for the OT.

Psychologist another huge money suck for us. $165 per visit, once a week, indefinitely? And I just can't tell if it's doing anything useful.

I really don't mean to be rude, but: Why continue?

Because all the recommendations from teachers, pediatrician, psychiatrist (who prescribes meds) neuropsych etc were "take dc to a psychologist". We have been through a few. One "fired" us saying she couldn't help us, one we stopped seeing b/c it seemed like a waste, then this most recent one..I don't know why we are paying someone $165 to pay connect 4 with our child. I honestly don't know. Because we want to do the right thing? The cost is killing us though.

[Anonymous]

Yes, we can only see specialists that our developmental ped and insurance approve. At one point there were only two innetwork speech pathologists and they both sucked. We paid out of pocket and fought for a year to get covered. We cannot go to anyone and submit to insurance or it will be denied. We paid out of pocket for an evaluation as we did not agree with the developmental ped. Many families I know pay out of pocket with no insurance help. It sucks.