Anonymous wrote:

Anonymous wrote: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.

On your taxes that is.

You can only deduct it if it reaches a really high amount in total and you itemize. Not many people get there.

Anonymous wrote:Monday morning quarterbacking in key. Make sure what you are doing is really working and moving your daughter forward. You will likely find that things that are recommended are not helping but it’s easy to get caught up on second guessing yourself when you think about ending.

Make sure you have clear and meaningful goals for each therapy and distinguish between goals and meaningful goals.

+1. wish I could get the time & money back that I wasted on Unstuck and On Target.

and don’t forget that your child is a child, and deserves to also learn all the fun stuff that will enrich her life - sending her to 4 days/week tutoring and therapy and not doing any swimming lessons, music lessons, or dance lessons is no way to live.

Anonymous wrote: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.

On your taxes that is.

Monday morning quarterbacking in key. Make sure what you are doing is really working and moving your daughter forward. You will likely find that things that are recommended are not helping but it’s easy to get caught up on second guessing yourself when you think about ending.

Make sure you have clear and meaningful goals for each therapy and distinguish between goals and meaningful goals.

Anonymous wrote:OP here and so far we have done everything out of pocket through providers who don’t submit to insurance. Her pediatrician was useless when we shared the issues DD is having so we got a recommendation from her school for a provider to do a neuropsych and paid out of pocket.

You are getting an IEP right?

just because the neuropsych (that you no doubt overpaid for) listed a bunch of stuff, that does not mean you need 5 different therapies at once.

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.

I always get blasted on here when I point out that everyone is out for SN parents’ money and that you need to be very discerning about what you throw money at.

Just because someone did testing and said your child has all of these conditions does not mean they all need therapy or the type of therapy suggested or all the therapy at the same time.

Nothing can substitute for you yourself knowing your child and identifying the key challenges that need support right now.

If she is in K and struggling with reading and writing, then you need OT and a strong IEP with pullouts.

If she is in MS and not completing homework, then more structure and routine.

If she has anxiety affecting her daily, then evidence-based therapy like SPACE.

and so on.

At a minimum, get on a waiting list for a therapist that takes your health insurance. Don't drop the current one until you have a new one lined up.

Prepare for your child to live a more basic life. Find some strengths and help them develop them. Most people run out of money and can only do so much.

OP here and so far we have done everything out of pocket through providers who don’t submit to insurance. Her pediatrician was useless when we shared the issues DD is having so we got a recommendation from her school for a provider to do a neuropsych and paid out of pocket.

Any tips on what I need to submit to get the anxiety therapy covered? Will the neuropsych be enough or do I need a Dr prescription/referral for it?

She has a dysgraphia diagnosis — any experience with getting insurance to reimburse OT for that (and what did you need to submit to justify it)?

Anonymous wrote:My DD recently diagnosed with ADHD, anxiety, and several learning disorders. We need for her: weekly OT, weekly therapy for anxiety, and two times a week tutoring. These therapies/tutors cost $700 a week. That doesn’t count the Dr to prescribe ADHD medication, which I’m hoping will be covered by insurance.

What can we do to offset these costs? Does anyone have experience getting the therapy and OT covered by insurance and what do I need for that? Can I get the tutoring covered by insurance or talent out of a 529?

Any thoughts on how to cope with these costs would be appreciated. Thanks in advance!

Drop the ot except for handwriting help, but you can do that at home. Online tutors can be cheaper. Therapy should be covered by insurance.

We got speech and OT covered by insurance (CareFirst), but we have an autism diagnosis and I've heard that covers a lot more than ADHD. But it doesn't hurt to call insurance and see what can be covered.

*take it out of a 529 (autocorrected to talent…)

My DD recently diagnosed with ADHD, anxiety, and several learning disorders. We need for her: weekly OT, weekly therapy for anxiety, and two times a week tutoring. These therapies/tutors cost $700 a week. That doesn’t count the Dr to prescribe ADHD medication, which I’m hoping will be covered by insurance.

What can we do to offset these costs? Does anyone have experience getting the therapy and OT covered by insurance and what do I need for that? Can I get the tutoring covered by insurance or talent out of a 529?

Any thoughts on how to cope with these costs would be appreciated. Thanks in advance!