Insurance coverage: nutrition, food texture issues etc. for preschool/K aged ASD child

[Anonymous]

I am reading our insurance contract (first time I have ever done this) and it appears that a "Covered Service" depends on whether someone says it is "Medically Necessary".

In practice, do typical insurance plans cover nutritionist services and sensory issue related therapy (whether by SLP or OT)?

We have celiac as well as ASD, so I am assuming that there is an argument that it is, but am wondering what people have seen in practice.

We do not have failure to thrive, in case that is relevant. We are slim but not grossly underweight.

[Anonymous]

No.
Sometimes you can get OT for low oral muscle tone though...

[Anonymous]

A lot depends on how it is billed.

For Celiac, we got insurance coverage because the nutritionist was at the doctor's office and it was billed as part of a doctor visit.

DSM V does not recognized Sensory Processing Disorder, so you can't get coverage for that. If it is billed as occupational therapy for autism, you might get coverage, depending on how "autism friendly" your coverage is. Some insurance companies try to exclude certain services for autism because treating autism is expensive and there is a perception that nothing really helps (even though this isn't really true).

The easiest way to find out is to ask your provider what diagnosis code and procedure codes they would use, then call your insurance codes and ask if they cover those codes.

[Anonymous]

Anonymous wrote:

The easiest way to find out is to ask your provider what diagnosis code and procedure codes they would use, then call your insurance codes and ask if they cover those codes.

Sorry, that should read "call your insurance company and ask if they cover those codes."

[Anonymous]

UHC covered speech for my son for sensory related feeding issues. I think OT was not covered under my plan for this.

[Anonymous]

I think if you have a diagnosis of a feeding disorder it helps with insurance.