Is insurance covering ST for ASD kids - pragmatics and the like?

[Anonymous]

I see conflicting things in the archives.

If so, what insurance providers?

Any tips for figuring out whether it is covered, and how to get it covered? Our daughter scored in the first percentile in pragmatics, even though she has very high IQ scores etc. She is profoundly challenged in the pragmatics area, and has no friends and a very difficult time having a reciprocal conversation. The school is only offering a weekly lunch bunch during part of the school year.

[Anonymous]

Federal blue cross does

[Anonymous]

Check with your insurance as to what is covered.

[Anonymous]

Ours covers speech therapy. Doesn't hurt to try. Usually with autism and a good justification they cover things.

[Anonymous]

Does your DD have a diagnosis and an IEP?

Sounds like your school is offering nothing. At our school, lunch bunch is open to everyone. If your child has such severe pragmatic issues, she needs an IEP so that she can receive speech therapy for pragmatics at school. Another benefit to getting pragmatic help at school is that your child can practice with her peers in the environment where she needs to use pragmatic speech.

My DS who scores 99.9% on vocabulary and similes on the WISC gets 1x wk speech therapy for pragmatics at school since preK4 now in third grade with no end in sight. Pragmatic issues are not something that will resolve even with many sessions but will change and only get more challenging as your child gets older.

[Anonymous]

OP here. Thank you for all of the quick responses! I understand well that the school should be providing services but they are incredibly difficult and my son has lost two years of services already. If I can get insurance coverage, I need to take matters into my own hands and stop standing by while he suffers.

What diagnosis codes work for those who are receiving coverage?

Many thanks again.

[Anonymous]

United Healthcare covered private OT and Speech under 220? or whatever the autism code was. But we could not find anyone who took insurance and had to submit for reimbursement after paying out of pocket. Better than nothing.

[Anonymous]

The other option is U of MD, GW (or maybe Georgetown) and Loyola in Columbia all have speech pathology schools with a clinic and its much cheaper if you have to private pay.

[Anonymous]

Anonymous wrote:OP here. Thank you for all of the quick responses! I understand well that the school should be providing services but they are incredibly difficult and my son has lost two years of services already. If I can get insurance coverage, I need to take matters into my own hands and stop standing by while he suffers.

What diagnosis codes work for those who are receiving coverage?

Many thanks again.

OP, which insurance do you have? Call them directly to find out your coverage. Many ST don't accept insurance so most likely you'll need to pay out of pocket and get reimbursed later. In terms of which codes to use, I would ask the ST not the insurance company.

As far as I know, National Speech in Bethesda still accepts insurance. Your current insurance may have in-network STs as well.