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[quote=Anonymous][quote=Anonymous]Therapy for anxiety should always be covered. The question is do you have out of network benefits. If you only have in network and see someone out of network, you can’t be reimbursed. If you have out of network coverage, you can submit a superbill for partial reimbursement. What they reimburse depends on your plan deductible, coinsurance and what the rate is they consider reasonable. When my kids saw out of network providers under our old Cigna plan, we paid the first $750 in full and then they paid 70% of each visit. They considered the amount the therapists paid reasonable so reimbursed 70% of the full fee. Now we have a lousy plan through an Aetna subsidiary that has a $5000 deductible and then will only pay 50% of a discounted rate. So we have to cover the first $5000 in costs out of pocket and can then be reimbursed 50% of what they’d be willing to pay. I think when we hit the deductible we’ll get back something like $75 a visit which isn’t much but beats nothing. So it is very plan dependent.  For this reason, we cut one back to every other week and the other is now on a sliding scale. Ask the provider for options if you truly can’t afford it. As for OT and speech, my kids had both years ago. One was covered under what I think was called the Habilitative therapy act in MD. The other 2 were initially rejected for speech but eventually we were able to get them covered. We filed an appeal and we also then had to ask the SLP to send periodic progress reports to justify continuing. It’s a pain but well worth it. Don’t give up on it. As for OT, our plan when they were young always covered it. Some OTs know which codes are most likely to be reimbursed so that can be helpful. For example, my kids all had hypotonia and one had a muscle weakness, so she used those diagnoses rather than something like dysgraphia.

Finally, you can keep good records and take all of it off (minus tutoring) as medical expenses. [/quote]

Speech can be plan dependent. I would encourage you to look into doing the above (though SLPs will not code for an issue without a medical diagnosis, so if your child doesn’t have hypotonia I would not go down that road for dysgraphia).

United viewed our child’s speech issue (stuttering or disfluency) as a mental health issue and then reimbursed at the OON rate for mental health.

I would also echo a different post about focusing on the most pressing issues for your child’s age and grade and reinforcing at home to the extent possible.

Our child was struggling with disfluency at 3 and medically disfluency is not viewed as a problem until 5 even though our child was very frustrated and struggling. I worked with our child every night on SLP homework and she attended Speech 1x/week and she saw amazing improvement. The SLP actually said that our child was able to use the tools better than older children, perhaps because of a lack of self consciousness. Of course the success of this type of intervention was never studied in younger children because it’s not viewed as a problem. So trust your gut when it comes to your child’s and reinforce at home. [/quote]

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