Question re: speech therapy and insurance

[daughtersrus]

Not true...My son gets speech, OT and PT through our school system. He just turned 3 in Jan. While his speech and OT might be educationally based. The PT is not, that is medically based. He has tights muscles in his ankles and calves..

Although it's a medical issue, having tight muscles in his ankles and calves could impact his education as well (not being able to floor sit with the other students, participate in gym...) so that it would still be covered by school. There's such a fine line where medical/educational meet and often cross. I've found that school districts will often use that to their advantage for saying that they're not going to cover therapy and hope that parents will not pursue it further.

I was just trying to point out that technically schools are not obligated to provide medically based therapy and most insurance plans are not required to provide educationally based therapy.

 

[MnMomtoboys]

Not true...My son gets speech, OT and PT through our school system. He just turned 3 in Jan. While his speech and OT might be educationally based. The PT is not, that is medically based. He has tights muscles in his ankles and calves..

Keep in mind that preschool special ed has different requirements than school age.


MomofMikey have you checked with your Doctor about speech? When our son John started the length of how many sessions and the time frame that was needed was suggested by him and then approved by ins. When John was 31/2 he started speech and OT through Courage Center. He was already in school for this also. After too many years he graduated from OT but then we still did speech for a few years after that. Most places will not go for more than 45 minutes because the kids get tired of being there.

LIke I said check with your Doctor about the sessions. He might be able to help you with that.

 

[klj27]

Back to the original question... our insurance gives us 20 ST/PT/OT visits per year. It doesn't matter if the visit is 1/2 hour, 45 minutes or an hour (we have had all three). For us one appt is equal to one visit.

 

[LuvOrlando]

My DS is now seeing a speech pathologist for Vocal Chord Dysfunction, VCD. While he has Asthma it's not the same & causes his vocal chords to collapse and obstruct his airway. At the moment he is learning how to breathe properly and control the condition. Anyway, our sessions run 1 hour each. I suspect the time allocated has more to do with the service provider than with Insurance. I'd keep asking around. Also, how is it the school can reject you if a Dr says you need the help? Can a Dr step in to petition the school to change? Is the school waiting for you to exhaust Ins before stepping in? No matter what I would push the school to give me a list of the criteria they want met in order for them to help so you can discuss it with your Dr.

Good luck

 

[MnMomtoboys]

My DS is now seeing a speech pathologist for Vocal Chord Dysfunction, VCD. While he has Asthma it's not the same & causes his vocal chords to collapse and obstruct his airway. At the moment he is learning how to breathe properly and control the condition. Anyway, our sessions run 1 hour each. I suspect the time allocated has more to do with the service provider than with Insurance. I'd keep asking around. Also, how is it the school can reject you if a Dr says you need the help? Can a Dr step in to petition the school to change? Is the school waiting for you to exhaust Ins before stepping in? No matter what I would push the school to give me a list of the criteria they want met in order for them to help so you can discuss it with your Dr.

Good luck

Ok its hard for me to explain this but here goes. Say that speech is evaluated on a scale of 1 to 10(this is just a simple example not how they actually do it) and the cut off is 6 and your son is at a 5. For schools in MN you have to be at least 2 levels below the minimum. You would still be accepted for private sessions but just not through the school district. And if your child is younger than 3 the level in MN is 1.5 under the cutoff.

I hope that explains it enough. There is much more to that but that is the simple explantion as to what the cutoff means.

 

[TiggerStac]

He got tested through the school already, but didn't qualify. Apparently, from what I've heard, it's tougher to get it through the school, I'm sure because of funding. That's why I went the insurance route.

Thanks!

This has to vary state by state. In MA for EI prior to age three, they need a 30% delay. For 3+ they need a 6 month delay (at least for preschool level, not sure if it changes after that) My son had 5 or 6 1 on 1 visits before he turned 3. We have his team meeting on thursday, to see if he qualifies now. I got his report today and it looks like he will.

My son is in speech. He is denied all of his care and the state of Florida through Early Steps paid for his speech unitl age 3 (Wednesday). Then we transfer to the school system.

The type, length, and frequency of his speech were specifically determined based on his deficiencies.


My son has had speech since the age of 20 months.

That's what happened w/us. Our insurance does not cover speech for a delay, they only cover it if you had it and lost it! I was really nervous when I found out about this. I spoke w/the EI program and the state actually pays for the visits if your insurance denies it or if its' copay/deductible. We had to pay an annual fee based on our income, but it was prorated as he was only in program under 3 months. 3+ is fully funded thru our public school system. 1/2 of the preschool slots with the town are set up for EI kids.

Hope someone may know the answer... I have Emblem health insurance. My 7 yo DS qualified for speech therapy today. The therapist mentioned that Emblem covers 10 sessions, which I knew. I was a little surprised though that the sessions are only 20 minutes long. Does anyone know if those 20 minutes are determined by my insurance or the doctor herself? I'll call Emblem in the morning and find out, but I figured I'd check here first It seemed sort of short to me, and I figured if I was getting 10 sessions covered, and a different doctor would allow more time, it might be worth it to switch.

Thanks!

I'd ask insurance co. It may only be how long the therapist spends with them. It seems low, but then I thought about PT I had, I spent 5 minutes warming up on bike, worked w/PT about 20 minutes and had 15 minutes of ice. So really only 20 minutes of PT time w/out the before/extra on my own.

School is only required to provide therapy that is educationally based. If therapy is needed for medical reasons it's not provided by the school district.

If it's needed for educational purposes, most health insurance will deny the coverage.

What do you mean if it's needed for educational purposes?? My son is in speech because he has perceptive/receptive/comprehension issues. Mind you...everything else is age appropriate and over age appriopriate on all his testing. But these things he's having trouble with. Would they consider that medical or educational??

 

[Lisa loves Pooh]

What do you mean if it's needed for educational purposes?? My son is in speech because he has perceptive/receptive/comprehension issues. Mind you...everything else is age appropriate and over age appriopriate on all his testing. But these things he's having trouble with. Would they consider that medical or educational??

Based on my son's IEP interview last week--


The impairment will negatively impact education is what that means. My son was tested on everything--he was only deficient in speech. But other areas have expected scores before the state will pay for services--and they only pay for those services that negatively impact education.

The inability for people to understand my son, would intefere with his education and thus he qualifies for school services and that was sort of how it was worded on one of the papers that I signed last week.

 

[LuvOrlando]

Ok its hard for me to explain this but here goes. Say that speech is evaluated on a scale of 1 to 10(this is just a simple example not how they actually do it) and the cut off is 6 and your son is at a 5. For schools in MN you have to be at least 2 levels below the minimum. You would still be accepted for private sessions but just not through the school district. And if your child is younger than 3 the level in MN is 1.5 under the cutoff.

I hope that explains it enough. There is much more to that but that is the simple explantion as to what the cutoff means.

I understand. You did a very good job explaining. Can I ask, do they tell you what defines each level? As a parent I'd want to know so I could stay ahead of the curve if the problem progresses.

It's terrible the way they make us jump through hoops for our kids. I HAD to get a special permit to allow me to drive up to the school with my DS12 when his Asthma flares up. You wouldn't believe the trouble they gave me. The Nurse even made a swipe saying, "I don't know if they'll give it to you. No other Asthmatic has ever needed it before." To which I replied, "You mean to tell me not one single parent of a child whose lungs close down suddenly has ever considered the fact that walking 1/4 mile to the entrance from the street might be a bad idea? No-one has ever considered that being on a bus for 20 minutes with no medical help and a bunch of kids covered in perfume/ cologne might be a problem?... REALLY" Then she zipped it and I got my doggone permit.

Good luck with your Insurance, I hope you can get the help you need without too much trouble.

 

[monarchsfan16]

LuvOrlando, I know you didn't ask me, but I can answer. In schools, eligibility is basically entirely determined by standardized testing (and then they also throw in that clause about it impacting the child's education). To qualify for services a child has to be so many standard deviations below the mean for the assessments they are given. So one can't necessarily tell you what defines a "level".

 

[Nicolepa]

My son has been in private speech therapy since he was 4 (now 8). His sessions are 20 minutes, but they usually last 30. It seems to be the standard at least around here.