For the life of me, I will never understand how or why insurance companies limit the amount of therapy visits a patient can receive. What is the number based on….other than the old might dollar!!! Therapy services allocated per year, at least in my case is 60 visits. The number includes occupational, speech and physical. If my son required all three, which he did at one time, he is only covered 20 weeks out of the year. What am I suppose to do the balance of year? What are my options?
• Cover the cost out of pocket at $1,000/week
• Determine which therapies are most important and attempt to perform the others on my own
Not only does the insurance company dictate the # of visits but they also determine if the treatment plan is required. Keep in mind, they have never seen my son, nor do they know his history but I have to fight tooth and nail with a customer service representative, who is not qualified to make the determination. As if I don’t have enough on my plate, I have waste my time pleading my case for his treatment. Last year, the insurance company tried to deny all of his therapies indicating they were not medically necessary. Really????? He has very little speech and struggles with fine/gross motor skills and has sensory issues. I consider those reasons medically necessary. Oh and by the way, I have a script from my doctor deeming the treatment medically necessary. I believe that trumps your decision. What a nightmare!
I challenge anyone from the insurance company to stand in my shoes for a day and then provide me with their decision. I’m sure if a few of the executives had special needs kids, requiring therapies, the criteria would be a little different. Don’t get me wrong, I totally understand the business end of things but not when comes to interfering with my kiddos progression.
I do realize that I am one person but this is a hot topic for me and MANY others and I plan to add it to one of the items I add to my list to take on!!!!! As always, I’m looking for your feedback and solutions?
{ 8 comments… read them below or add one }
When my son was in school, he needed all those therapies and more, several times a week each. With few exceptions, the school district provided all of it.
Lauren, the schools do offer therapy but it’s minimal. 15 for speech and OT.
We only get 30 visits a year. Its very frustrating. I try to learn everything I can while I am at therapy so I continue to implement what the therapist is doing once we run out.
Kim,
It is extremely frustrating and sad.
Karla
How about ABA? That was a whopping $10K out of our pocket for 15 hours a week for only 3 months so I could learn how to do it myself. Not. Fair.
Tanya,
It’s really unfair! Don’t get me started on the supplements that are not covered by insurance. They really need to spend one day in our shoes!!!!
Music therapy costs half of OT/PT/speech and will incorporate all of your OT, speech and social goals. Also, you can get parent training written into your IEP and learn how to do therapy at home.
Karen,
Where did you take your son for music therapy? I was discussing music therapy with his teacher and I know he would benefit from it.
Karla