Autism-Insurance-Diapers

[marius97]

A family member has a newly diagnosed as autistic DS3. Someone she knows mentioned that one he turns four, a doctor can prescribe diapers for him (he isn't close to potty training) and insurance will pay a portion of her costs. Obviously every insurance is different, but has anyone heard of some insurances paying for diapers past a certain age?

 

[mistysue]

I haven't, but that has to be a thing. I actually did a quick search and these seemed to have some helpful information, that second link says it may start at 3!

http://www.savingcase.com/index.php/2011/09/12/got-diapers-diaper-coverageby-insurance/

http://community.babycenter.com/post/a33931561/how_do_i_get_insurance_to_cover_diapers

 

[clanmcculloch]

Wow, I never would have even considered this. My 15yo with Asperger Syndrome was unbelievably difficult to potty train beacause of sensory (like the feeling of holding it in) and obsessive compulsive (her bodily waste belonged in a diaper and only in a diaper) issues. She still wore diapers part time at 5. Luckily, she did have enough social awareness to become embarassed at that point so she quickly decided it was time to use the bathroom like the rest of us but boy was it frustrating not to mention expensive. Good luck getting it covered. I hope it works out well.

 

[lanejudy]

Yes, it is possible, particularly if the child is on Medicaid or state assistance. However, it will depend upon the insurance company approving the claim - and they may only approve certain brands and/or purchases from certain drugstores or online vendors. So your family member will want to look into that - the pediatrician likely is familiar with such a script and maybe even with their particular insurance. Good luck!

 

[mistysue]

Wow, I never would have even considered this. My 15yo with Asperger Syndrome was unbelievably difficult to potty train beacause of sensory (like the feeling of holding it in) and obsessive compulsive (her bodily waste belonged in a diaper and only in a diaper) issues. She still wore diapers part time at 5. Luckily, she did have enough social awareness to become embarassed at that point so she quickly decided it was time to use the bathroom like the rest of us but boy was it frustrating not to mention expensive. Good luck getting it covered. I hope it works out well.

Do you also read things like this and get left wondering why nobody asked around you all those years ago? My DD also just wouldn't potty train, we had to have a "you are going to enter Kindergarten soon..." talk. I had never even heard that covered diapers were a thing. That's why I searched for it. Would have saved so much money. I always hope it works for others, but also wish I could have benefited.

 

[blondietink]

Good luck with this. But I have found that most private insurance companies will not cover this. Mostly state Medicaid will in some instances, but usually have to have a medical diagnosis (incontinence, etc.), not autism or other disability.

DS was not potty trained until he was 8 years old. Would have liked to save all of that money, but our insurance would not cover diapers.

They would also not cover a special formula for my other DS who had a heart condition when he was born and needed a formula with high calories. We went through the appeals process and everything. Denied over and over again. At the time 23 years ago we could not afford $90.00 for 24, 4 ounce bottles of the high calorie stuff, so we had to make due with mixing a powered formula extra rich.

Can hardly wait for Obamacare to kick in to see how they will handle these kinds of issues.

 

[PatMcDuck]

I was told I could do this now that DS is on Medicaid (adult). i have not gotten around to it yet.

I DO take the expense off my taxes as a medical expense. Of course it only helps in the rare years I have enough in expenses to get the medical deduction.

 

[clanmcculloch]

Do you also read things like this and get left wondering why nobody asked around you all those years ago? My DD also just wouldn't potty train, we had to have a "you are going to enter Kindergarten soon..." talk. I had never even heard that covered diapers were a thing. That's why I searched for it. Would have saved so much money. I always hope it works for others, but also wish I could have benefited.

OMG yes!! Actually, at that time we still didn't have a diagnosis. I was so clueless back then. At this point I was struggling just to find out what was going on with her. Her preschool has a social worker come in to observe her and the social worker told me she saw some obvious sensory differences in her and that she would benefit from seeing an Occupational Therapist. I had never heard of an OT and had no idea what they did but I was excited to have somebody at least give me a direction. I called my insurance company for the name of somebody in network. The person with my insurance company said that OTs are for work related injuries (occupational, get it?) so that type of specialist was inappropriate for a child. You know, it still bugs me to this day. There was NO information available to me at the time. Forget about trying to get info about stuff like diapers.

 

[clanmcculloch]

They would also not cover a special formula for my other DS who had a heart condition when he was born and needed a formula with high calories. We went through the appeals process and everything. Denied over and over again. At the time 23 years ago we could not afford $90.00 for 24, 4 ounce bottles of the high calorie stuff, so we had to make due with mixing a powered formula extra rich.

Can hardly wait for Obamacare to kick in to see how they will handle these kinds of issues.

I'm shocked that this wasn't covered. WOW! Oh, 23 years ago. That makes a difference. I think it would be covered under most insurance policies these days.

I wouldn't expect Obamacare to make a difference. From what I understand, it'll only require that people are approved for coverage, not what is included in the coverage. Maybe I understand it wrong though since I haven't been watching all that closely.

 

[joanchris]

Most private insurance will not cover them. In many cases medicaid or state waivers will pay for them, but some states will dictate brands or cost per diaper. IMO when they restrict you to brands they are usually about as effective as sticking a paper towel on the person's bottom. Not worth the hassle of clothing changes and laundry etc.
When it's a cost per item it gets trickier. Where we are we can still get a decent product for my daughter. But if she grows any then the cost per item will be too much and they will not get that brand anymore. In which case I'll likely go back to paying for them myself again.
IMO an allowance of sorts $x per month towards whatever-brand-you-need diapers would be better, but nobody in charge listens to me!
It certainly doesn't hurt to ask!

 

[Lisa71]

Our insurance will not cover but any child over 3 can have them paid for with your health savings account so we do that.

 

[FortForever]

Do you also read things like this and get left wondering why nobody asked around you all those years ago? My DD also just wouldn't potty train, we had to have a "you are going to enter Kindergarten soon..." talk. I had never even heard that covered diapers were a thing. That's why I searched for it. Would have saved so much money. I always hope it works for others, but also wish I could have benefited.

Yes, I sure do! I am so glad to see the wealth of information and help available to today's parents. At the same time, it makes me sad to think how my son never benefited from any of it. I can only hope that awareness makes some kind of difference in his future. It hasn't yet and he is 23. Information is only available to those who look for it, which most people have no reason to.

OMG yes!! Actually, at that time we still didn't have a diagnosis. I was so clueless back then. At this point I was struggling just to find out what was going on with her. Her preschool has a social worker come in to observe her and the social worker told me she saw some obvious sensory differences in her and that she would benefit from seeing an Occupational Therapist. I had never heard of an OT and had no idea what they did but I was excited to have somebody at least give me a direction. I called my insurance company for the name of somebody in network. The person with my insurance company said that OTs are for work related injuries (occupational, get it?) so that type of specialist was inappropriate for a child. You know, it still bugs me to this day. There was NO information available to me at the time. Forget about trying to get info about stuff like diapers.

I know the feeling. I was so clueless and made so many mistakes that I can now clearly see. I wish I had some help and support back in the day. Although I didn't have the information when my son was little, he was in OT in school. The county paid for that as well as speech and physical therapy. Montgomery County, MD. Great schools there!

On the potty training issue. Wow, was that ever a nightmare! I knew my son was different at that age, but had no clue why. I tried to train him the same way and at the same age as his three older siblings. Had I known then what I know now, I would not have even tried for at least another year.

As it was, it probably took about three years before he was totally potty trained. Number one was easy. Number two was an issue. He would not go in a toilet under any circumstances for the first year. He would sit on the toilet, and when I left the room, he would get up and do it on the floor. I was horrified.

 

[cgncga]

A family member has a newly diagnosed as autistic DS3. Someone she knows mentioned that one he turns four, a doctor can prescribe diapers for him (he isn't close to potty training) and insurance will pay a portion of her costs. Obviously every insurance is different, but has anyone heard of some insurances paying for diapers past a certain age?

I'm in Canada and I know the rules are different here, but once my daughter turned 3 (I think it was) we could get reimbursed for some of the costs of diapers from March of Dimes. I'm pretty sure that they also have chapters in the U.S. so maybe that it another option to look into. I think we could get back $200 twice a year. I imagine (hope!) it would be more now. My memory of the details may be a little fuzzy since it was a while ago. My daughter will be 10 in November and was pretty much potty trained by 5, but it was helpful for a while.

Catherine

 

[gilesmt]

Yes, Medicare and tricker (military) insurance covers diapers for any child over 3 that is not potty trained. You do not have to have a diagnosis just a doctors prescription. I doubt private insurances pay, but then again you never know. Most doctors and no state worker will tell you this unless, you have a dd case manager, and then I would tell every client. You can not pick the brand, it is all from a home health store, like the ones who sell w/c and canes, or assistive toilet seats and such. But the diapers are pretty good, especially the pull ups.

No to the formula, there is no insurance that covers that. Some state agencies may help, our health department will help, wic will help for children under 5, and our agency DDD will help most up to $1500 a year, which I know is not much but at least it is something. E work very hard with doctors who put kids, adult on these very expensive formulas, sometimes they are just getting kick backs promoting them, other times they have tried 15 others and this is all that works. We as case managers, are sometimes successful at getting companies to supply some of the formula to the family at no cost, we have been able to work with the hard ship departments of several companies, ask your social worker at the hospital or your case manager for help in getting a hardship, to help supply the formula.

 

[FortForever]

Yes, Medicare and tricker (military) insurance covers diapers for any child over 3 that is not potty trained. .

Can children even get Medicare?

 

[kathleendsm]

My 5 year old son is on a state Medicaid waiver. We got the "diaper letter" from his developmental pediatrician last summer, and it has been a godsend! For some reason we do get name brand Huggies Pull-Ups (in the lovely Cars and Monsters University pattern), but not sure why except that her prescription did say pull up. Every month Target has a giant bag of them ready for us. They're terrible for night, so I take one, cut a few openings into the top layer to let liquid out, and then put another one on top. That works most of the time and saves us having to buy a special nighttime pull up.

If they aren't able to potty train him in kindergarten next year, I may look to see if there are larger options since he's in the largest Pull-Up size right now. He's a string bean but TALL.

If you are on the Medicaid waiver, ask your doctor about it. Our regular ped had no idea, but the developmental pediatrician does them all the time.

 

[lanejudy]

Can children even get Medicare?

PP probably means "Medicaid"

 

[gilesmt]

Yes, for children it is called Medicaid, maybe, it comes along with SSI or SSDI, or if they qualify for state Medicaid.

 

[blondietink]

Yes, children can get Medicare if their parent is disabled and drawing Social Security, is retired and drawing Social Security, or deceased and the parent worked to put in enough quarters to qualify for Social Security.

SSDI is tied to Medicare. SSI is tied to Medicaid. My son has both Medicare and Medicaid (waiver). Medicare will not pay for diapers. Believe me I have tried and so has the company I order them from. they know all the rules. Medicaid will pay for diapers, only with a diagnosis code attached to the prescription written by a physician.

 

[TinkDisneyGirl]

My DDs Tefra Medicaid pays for diapers and her pediasure. They are both delivered to the house each month.