Questions.....

iVillage Member
Registered: 11-07-2004
Questions.....
9
Tue, 05-16-2006 - 2:20pm
When your child was diagnosed, what type of therapy or additional care services did your child need? If they needed social therapy, does that go under your medical policy or mental health type stuff. Do insurance companies consider this a mental health condition?
iVillage Member
Registered: 11-07-2004
Wed, 05-17-2006 - 2:30pm
No, I am not responding to my own post. LOL I wanted to add to it. I am wondering what type of financial hardships has your family had in dealing with the cost of therapy, medical and so forth? Does insurance cover this stuff? i started asking these question because someone I know told me how they are about going broke over the cost of everything and how so much isn't covered by anything.
iVillage Member
Registered: 03-26-2003
Wed, 05-17-2006 - 3:00pm

Here's our experience....

Son was just diagnosed in December so we are just starting our journey.....

Son has been seeing a behavior therapist for a little over a year (she is the person who first mentioned the word "aspergers" to us). Son is from my previous marriage but his dad has a crappy job with no health insurance so my husband carries son on his policy. His therapy is covered by our health insurance (under mental health).....we have to pay a $40 copay per visit.

I have been trying to get son into OT but I can't seem to find anything for him.....we are currently on two different wait lists. This will be covered by our insurance - both centers have checked to make sure our insurance will cover OT before they put us on the wait lists. Unfortunately, son is not even receiving OT at school. The OT set up a sensory diet for him and he gets several sensory breaks throughout his school day but they feel he does not need OT - I don't agree with this and we are trying to get it for next year (new school - IEP meeting on May 23).

I may have found a social skills group for him to attend every other Saturday - it costs $70 per hour - not sure if any of this is covered by insurance.

I have looked into several different camps for this summer but they are way too expensive....we could never afford them being on one income. One was a social skills camp - $350 per week for 6 hours of therapy (per week). Another was a week long day camp with ST, OT and hippotherapy - I would have LOVED to send him to this but it is over $3000! Not unless we win the lottery (very slim chance of that since we don't even buy the tickets - LOL).

That's all I got so far....

Christie

iVillage Member
Registered: 11-07-2004
Wed, 05-17-2006 - 3:07pm
Thank you so much! From what I can tell any OT will be covered on our medical plan with a $15 co-pay. The mental policy is what I need to understand, it appears you are limited to 30 sessions a year. I am not sure if that can be extended and if it will cover social therapy. I heard that there is only one person that does it in our area and it is $50 a session. I guess I am just trying to prepare myself for what type of financial responsibilites we will have.
iVillage Member
Registered: 01-19-2005
Wed, 05-17-2006 - 3:57pm

I think that a lot depends on your insurance company, but for us it has been a pretty significant financial burden.

Our insurance company, AvMed specifically excludes all therapy for autism. It does cover medical things--evaluations, neurology, psych-- with a copy. Their reasoning is autism can't be "cured" so all treatment is "experimental." Our neurologist has tried several times to explain the medical necessity for therapy. He has even tried using diffferent codes on the forms. To no avail. If Eric had a stroke and lost speech, he would be allowed a certain number of ST sessions a year. Since his speech problems were due to autism, the company will not cover. Same for OT.

My son was diagnosed at around 18 mos. He required behavioral therapy twice weekly (two hour sessions), ST 4x weekly (1/2 hour sessions), and OT 4x weekly (1/2 hour sessions). Our insurance would cover none of these services, so our state's "Early Intervention" program covered everything. You just had to use certain providers, but when we were starting, almost everyone in our area was a provider. So his services were covered until age 3. Ah, those were the days!!!

At age 3, we were no longer eligible for early intervention. In theory, there is a transition from the early intervention program to the school system. However, in our county, the school has much higher criteria for recommending ST, OT, PT etc. than the early intervention program. That is, a child needs a much more significant delay to get services at school. So although our son qualified for a special ed autism pre-K, he only qualified to recieve one 30 minute group ST / OT session a week at school.

Since we felt he needed more individual therapy, we have had to pay out of pocket. The ST is $89 for 30 minutes and OT is $112 for 30 minutes. Our son only goes twice a week to each now. We are looking into dropping one OT and ST session and replacing those with a social skills group that is $45 for one weekly hour session (4 kids, taught by one ST and one OT). (But we are doing this bc Eric needs the social/pragmatics skills and is ready, not to save $$, although it will.) We obviously cannot afford all this and have accepted money from loving relatives to help us out. It is almost the cost of a college education! We no longer go use a behaviorist, but do not feel Eric needs one now.

We too found the cost of summer camp high, but no more than the cost of therapy. Summer camp here is also $300 per week. Since it is taught by an ST and OT, we are skipping individual therapy for the summer and putting those $$ towards the camp. Also, we got a small scholarship from our local ASA to cover part of the tuition. The ASA has been a source of financial support for recreational activities. For example, our son takes a special gymnastics class for ASD children and the local ASA gives us 1/2 the tuition. They offer this for hippotherapy and a few other sports things.

It is definitely a financial burden. But we have seen Eric improve tremendously and we hope to phase out the ST in time, in favor of the social skills groups which cost less. He may need OT for awhile, however. But we look for OT sources in other ways (like sports, swimming, the playground).

I know this is not encouraging. Hopefully this will not be your situation, but several of my friends locally are in the same boat as we are.

Katherine

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Registered: 11-07-2004
Wed, 05-17-2006 - 4:14pm

Thank you, while it may not be encouraging- I want realistic so I am not in shock!

I just can't believe your insurance co excludes treatment for autism. That is just ridiculous! I have heard that the social skills groups are very effective. Lord knows my son could benefit from this group.

Summer camp was a challenge for us. We have no camps for special needs in his range in our area. Both my husband and I work full time and must have care for him. While we have a retired grandparent, we can't count on them on a regular basis. So, he is signed up for our local recreation center program. I am afraid we may regret this decision. Although, he goes to this rec center after school everyday for an hour and seems to like it. The only saving grace is that is 12 year old sister will be there also. She will be checking in on him often. I worry about others picking him on him! I worry about a lot of things!

iVillage Member
Registered: 03-26-2003
Wed, 05-17-2006 - 5:13pm

Some things go under my medical insurance, some under mental health, some where/are state dept of developmental disabilities, some are school and some are private pay.

Over the years my kids have gotten a variety of therapies from different sources. Typically, what I do is make a list of the biggest issues I want to address are. Then start to make a plan on how to address it. Then I look at all those areas and see what is available, what can I do myself, and what do I have to pay for.

Social skills therapy has come from school, mental health insurance and private pay. Currently my kids therapist that works on social skills is covered by our mental health insurance. The medical insurance does not cover that.

Currently my kids biggest needs are in the area of social skills, executive functions and sensory integration. Some of that is provided in school. Both Cait and Mike have social skills groups in school, Mike has a sensory diet and Cait is being evaled again, and executive function is addressed through thier IEPs

outside of school, Mike goes for additional social skills through play therapy. Cait will go again to a social group soon. These are covered by mental health insurance. Mike will be going to a sensory summer camp program for kids like this and goes to karate, Cait gets theraputic horsebackriding. Those are all private pay.

There is more but that is the current stuff for those issues.

Renee

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iVillage Member
Registered: 10-03-2004
Wed, 05-17-2006 - 5:30pm

Hi -

Our insurance would have allowed us 30 psychotherapy sessions a year, but the woman we work with is not in the network and those who are in the network we had never heard of. So we pay for that (expensive!) ourselves. For years we did outside speech through a university training program, which was pretty good and not very expensive at all. We used swimming lessons and other physical training (Tae kwondo, horsebakck riding, etc.) once we no longer could get extra outside OT through Early Intervention -- our son has always had 2 half hour OT sessions a week through school districts and still does. Also 2 xs speech and 2 xs behavior therapy, seems to be standard services here.

We have paid for small groups play therapy out of pocket as well, not covered by insurance. In fact, our insurance has not really helped with anything (as he is never physically sick, knock wood). This is because we go to the best in ASD field and they are never providers... Have we gone broke? Not yet, but I am working many extra hours to pay for much of it. Fortunately, I am a freelance persoanl trainer and can make my hours around my son's schedule. Also, my husband works freelance so we can trade off and not have to have too many sitters.

AND we deduct on our taxes. This stuff all adds up, and we do get more back because of itemizing --- which we already must do as ferelances --- so at least we get some back HOORAY!

Sara
ilovemalcolm

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iVillage Member
Registered: 03-25-2003
Wed, 05-17-2006 - 10:57pm

I'm learning as I go as well.

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iVillage Member
Registered: 01-19-2005
Thu, 05-18-2006 - 8:09am

I just had a couple of other thoughts. One is about tax deductions, Sara is right, you can deduct all the stuff not covered by insurance. We got back a nice chunk this year too, and it goes right out the door again for more therapy! LOL! As of this year, you can now also deduct mileage to therapy, which for us was a biggie as I drive 45 min. one way to take Eric and I do this several times a week.

Also, some employers have a benefit where you can put money into a special account that is just for health related costs and you do not pay taxes on this. I can't remember what it is called (we don't have it, but a friend does). If you know for sure what your expenses are, this is a nice thing.

Katherine