So frustrated with insurance company...

[KateandtheGirls]

Nothing you guys can do, but just had to get it off my chest.

You may know that we're in the US. My 5yr old dd had a speech evaluation at the end of May, and the results were that she has a moderate to severe articulation disorder with her oral motor skills being moderately impaired. She has a lateral lisp, and they recommended that she had speech therapy twice a week.

We came over to England for 2 months after that. As soon as we got back I contacted my insurance company to get the speech therapy authorized so that they would pay for it. I hadn't heard anything, so called them back today and left a message wondering what was going on. The hospital where the speech therapist is based just called me and told me that the insurance co. requires a new evaluation because it's been so long since the last one, and they can't fit us in until December.

On top of that I just got a bill from her pediatrician for $150 because the insurance co. is refusing to reimburse him for her annual check up. I have no idea why, it's supposed to be covered. I couldn't get through to a real person on the phone, but the automated system told me they would send me a written explanation in 7 to 10 days.

What a pain in the neck.

What a pain Kate - my brother finds the whole med ins system bewildering!! Good you can have a rant about it here - pity mn can't pay the bill too!

KatG, argh! I'm amazed that your ins company is covering the speech therapy, though. Who are you with? Excellent! Hope everything else gets sorted soon. And what a pain!!

have you seen the apraxia kids website - I think they have a guide to getting insurance companies to pay out?

Can guarantee you're better off in the US though. My non-verbal 5 year old autistic son has had no speech therapy from the NHS since March. The LEA have finally paid for his private therapist (who he sees once a week) to go into school- but only after I threatened to take them to the local givt ombudsman for failing to meet the provision as set out in his statement. We have private health care- but it won't cover SALT- infact almost didn't cover ds1 at all because of his autism (I had a bit of a fit about that one!)

The ins co case manager called me back, and apparantly they wouldn't cover it anyway, because a lisp is a developmental thing, it's not because of an illness or disease. Doesn't make any sense to me. They covered the cost of a pediatric neurologist and occupational therapist when she was a baby, and that was because of a developmental delay.

Anyway, she seems to think they are being nice by offering a second evaluation, and if anything different comes of it they will reconsider whether they will cover any therapy. I don't see how the diagnosis is going to be any different though.

I guess the next step is to find out what the cost would be to pay for it myself and decide if it's worth it.

She might qualify for FL's early intervention program. Or check with her school district -- they're supposed to pick that sort of stuff up when kids get too old for the state.

My sister and SIL have used their states (IL, CT and now NV) early intervention programs and have good things to say about them. Unfortunately, I don't know who you'd call to find out...

Just googled this -- hth a bit.

JJ, thanks SO much. I just talked to someone at the hospital and she put me in touch with someone from Scottish Rite, who is going to call me back tomorrow. I'll take a look at the website now.

Here's the link to apraxia kids with the articles about getting insurance to pay. Apraxia is developmental as well.

Thanks jimjams. You guys are the best!