Excuse me, $126 per WEEK is a ton.

$126 per month is a ton of money. It it is not to you, stay off the thread.

It is a huge problem that so many OTs, PTs, psychologists, and psychiatrists don't take insurance.

I work at a small employer and do not have out of network coverage...Only a couple insurance choices and the one that offers OON coverage is not affordable for premiums and has huge deductible anyway so it is not an option. I am jealous of Feds! (I have applied and been a finalist but not selected).

Anyway I start by calling insurance and getting lists of providers. Then I call providers to see if they actually take insurance.

That's my strategy. I have found OTs and a couple of therapists that take insurance.

Good luck.

Anonymous wrote:Also your insurance may have a clause - no providers available with in a certain distance without a waitlist - that will allow you to see an out of network provider at in network rates. I'd call and say look, we can't find a provider within x miles without a waitlist, what is the process for getting an out of network person covered at in network rates. And then they either tell you the process or, like my insurance, dig up someone local without a waitlist. Not a guarantee, "local" for our insurance is 50 miles (hah!), but worth a try.

This is what we did for some of our providers and we were successful although it was a lot of letters and each permission to go OON was per quarter so you had to keep up with the letters. Look up gap extension, letter of medical necessity online and begin getting documentation from your referring md.

OP here: wow, this board is something else and I will choose my words more carefully IF I ever post in the future. Thanks to those who provided helpful advice. I was simply looking for a good in-network option with the mounting costs of having two special needs kids. The "high income" comment was simply expressing a broader frustration that, if this is hard for us, it must be impossible for some. FWI
W, a lot of DC would not categorize us as "high income" but we are not struggling to pay the mortgage. We are living paycheck to paycheck without a lot of discretionary spending, but I am not complaining. I am just trying to explore options for good help for my kids and feel it should be covered by insurance like any other medical issue. Things are hard enough for those of us who have kids who need these services. They should be covered. (AND, we shouldn't have to be called "complainers' or otherwise criticized by other parents who we look to for support! Geesh!

Also your insurance may have a clause - no providers available with in a certain distance without a waitlist - that will allow you to see an out of network provider at in network rates. I'd call and say look, we can't find a provider within x miles without a waitlist, what is the process for getting an out of network person covered at in network rates. And then they either tell you the process or, like my insurance, dig up someone local without a waitlist. Not a guarantee, "local" for our insurance is 50 miles (hah!), but worth a try.

There are some therapists who take insurance. We didn't have success finding a good one, but there are some. For psychiatrist, honestly, I would go out of network unless you get a good recommendation. Children's has a long waiting list and a bad psychiatrist is worse than none, IME. It's expensive, but not weekly, so a little easier to budget for.

FWIW, we have spent $13,000 out of pocket on non-network providers this year, after giving up on the in-network ones we were seeing. It is a huge problem that people who live in other parts of the country do not seem to have. Maybe it's the DC area mental health care market? We live like we're poor and have mounting credit card debit, but it has been the best money we have ever spent - it has saved my DC's life.

Good luck finding help.

Anonymous wrote:Our younger DD is on the spectrum (and ADHD/Dyslexia) and has been in multiple therapies, etc. since she was 3 (she's 7). Our older DD (9) now has developed issues that may be ADHD/depression/anxiety. We take 7 year old to KKI CAARD (travelling 1 hour each way) for therapy because we just can't afford to pay out of pocket and it is covered by Fed BCBS. We have taken our older DD to an out of network provider for an intake and is set up for weekly appointments short term but we just discovered they will cost $126 per week (we are very minimally reimbursed). She will also need to see a psychiatrist for possible meds. Can anyone recommend how to get these services locally through Children's or KKI? We are well aware that there are no other in-network providers available. This is a huge problem in my opinion - how are parents supposed to get their children the help they need!?? We have relatively high incomes - I can't imagine what this would be like for someone who doesn't. Their kids would just not get help!

Carefirst has relatively few in-network providers, but you are a fed. Some parents have posted here recently that they get pretty good ASD services through Kaiser. Is open season still open? Might be worth exploring.

Anonymous wrote:^^^For some people this is a lot of money and is the difference between eating or rent. Wake up and can the sanctimony.

Plus 1!!!

This isn't that much help, but in case you haven't thought of it ... make sure you're putting money into your company's FSA program, if they have one. If you're at a 40% tax rate like we are, that brings the $126 down to effectively $75.
I think you probably can find in-network but it will probably involve a long drive and maybe someone who's not that good. I think the better approach is to find a therapist with a clear cut plan for what they are going to do, and how long they anticipate it will take. It's the year upon year of weekly therapy that is really a money drain.
Also, the prescribing psychiatrist (at least in our case) only needs to see them 4x a year, so that's not too bad. I am always questioning how much benefit a little kid actually gets from weekly talk therapy...you may also be able to get some of that service for free from your public school -- if she is having anxiety that interferes with her schooling, they may be willing to set aside a weekly or biweekly time for her to meet with the school psychologist, either through an IEP or informally. The school psychologist might even be more effective, because she will be familiar with the school dynamics and where the stressors are.
Good luck!

^^^For some people this is a lot of money and is the difference between eating or rent. Wake up and can the sanctimony.

Anonymous wrote:If you have a "relatively high income" you cut back elsewhere: vacations, eating out, clothing, etc, etc.

+1. $126 a week is not a lot of money. That's what most kids sports or dance practices cost weekly.

If you have a "relatively high income" you cut back elsewhere: vacations, eating out, clothing, etc, etc.

Are there no in-network providers available now, or at all? If not now, you keep following up with the in-network ones and try to get her in as soon as possible. Until that point, you keep going out of network.

We have one son with ASD and we currently spend about $4000 a month on therapies and shadows (this does not include school tuition).

It stinks but you do what you have to do.

You change your insurance, you get a different insurance plan, you go into debt or get government insurance. You have a high income so pay or find an in-network provider and stop complaining. We spend easily $1000-2000 most months. We don't have a high income but make it work.

Our younger DD is on the spectrum (and ADHD/Dyslexia) and has been in multiple therapies, etc. since she was 3 (she's 7). Our older DD (9) now has developed issues that may be ADHD/depression/anxiety. We take 7 year old to KKI CAARD (travelling 1 hour each way) for therapy because we just can't afford to pay out of pocket and it is covered by Fed BCBS. We have taken our older DD to an out of network provider for an intake and is set up for weekly appointments short term but we just discovered they will cost $126 per week (we are very minimally reimbursed). She will also need to see a psychiatrist for possible meds. Can anyone recommend how to get these services locally through Children's or KKI? We are well aware that there are no other in-network providers available. This is a huge problem in my opinion - how are parents supposed to get their children the help they need!?? We have relatively high incomes - I can't imagine what this would be like for someone who doesn't. Their kids would just not get help!