Question about insurance and SPD

[Anonymous]

My DS is going to be evaluated soon for suspected SPD. Just wondering if anyone has been successful at getting some, if not, all of the OT sessions paid for by their insurance for SPD? I called my insurance company (BCBS PPO) and they said they only pay for OT if it is a birth or genetic defect or if it is from an accident. I know I won't be able to afford private OT on a weekly basis if I have to pay out of pocket. I was told by a few people not to bother w/ ChildFind b/c they don't recognize kids w/ SPD as needing OT (they only would provide OT if it impacted their education). I am sure others are in this situation (or have been). Any ideas? My DS is 4 now and will be going to K in another year. TIA.

[Anonymous]

I have had luck having OT covered for SPD. I have Unicare and had my developmental pediatrician write a letter saying OT was medically necessary which is our buzz word. As for ChildFind, we are receiving OT services because the SPD also affects fine motor skills. For ChildFind, the key is that "SPD" is not recognized as something that receives service. You only get services if it impacts your child academically. However, they have a code for developmental delay which can allow for OT services if there is a fine motor delay - for a 4 year old, it's delay in cutting, coloring in the lines, puzzles, etc.

[Anonymous]

We are getting my DD OT sessions covered; SPD is still experimental and her diagnosis for insurance purposes is developmental delays with fine motor skills.

[Anonymous]

OP here. Thanks for the replies. Can I ask the PPs if they used the diagnosis of "developmental delays" b/c that is how SPD is seen or just so the insurance will pay for it? Does your child actually have a delay w/ fine motor skills? Mine does not.

[Anonymous]

The county is the one who uses the "developmental delay" code. For insurance, I think it is for "coordination disorder" and for me, there is an actual delay with fine motor skills. It's all related to the SPD since the focus is not consistently there in order to practice the fine motor skills but there is a clear delay there.