O.T.

iVillage Member
Registered: 01-03-2005
O.T.
6
Thu, 01-06-2005 - 5:10pm

I don't get it I want to have my daughter tested for SID/SPD and my insurance will cover OT if it is a medical condition, if it is school related like LD or a mental condition they will not. I'm trying to see if the school will pay and they tell me that they will not unless she is in Special Education. I guess my question is "is SID/SPD a medical condition?" God I hate this. My insurance is through the public school district where my husband works and where my daughter goes to school so if neither one of them pays for this I will be so mad.

Has anyone else had this trouble?

iVillage Member
Registered: 09-30-2004
In reply to: isherbear40
Thu, 01-06-2005 - 6:58pm

How exasperating, isn't it?


In all honesty, because SPD is currently *not* in a DSM (http://mysite.verizon.net/res7oqx1/index.html)it is not really recognized by the medical community. Your daughter will, however, qualify for OT services once she is diagnosed -- I would check but in NY we have a 504 accomodation plan for Madison & she gets OT everyday. It is *not* necessary for her to be in Special Ed' to receive those services, especially after getting her DX'd & then approaching the school with the documentation.


I'm only sharing what we did in all honesty, if anyone else has anything more to add, please do!


We had Madison seen by a developmental psychologist that provided the DX' of SPD, then off to an OT to second it -- our insurance was willing to pay for a limted amount of sessions but our Elementary school picked her up & she received OT through our school the summer prior to Kindergarten.


I'd say arm yourself with the DX & then go after the school .........


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iVillage Member
Registered: 11-16-2004
In reply to: isherbear40
Thu, 01-06-2005 - 8:29pm

Ugh, I just lost my whole message!

Yes, it is very frustrating. I've been on both ends. My dd would never qualify for school OT. She does get private OT covered by insurance, but only because she has some strange diagnosis code they cover.

On the other end, I was a school OT until 2 years ago. Every state is run differently, very differently. Techniqually a child does have to be special ed to receive OT services. But special ed might not be what you think. Speech qualifies you for special ed services. Why do you want her tested? If it is affecting her learning I would ask for a psych eval plus the OT eval at the same time. They types of therapy in the school and privately are very different.

Oh, and Colleen is right about the 504 and getting services that way. Every state is very different with that too though. In the county I worked in, no child had ever received OT through a 504 plan.
HTH and I am more than willing to try and explain more if you want to provide more info.
Michele

iVillage Member
Registered: 01-03-2005
In reply to: isherbear40
Fri, 01-07-2005 - 11:58am
Thank you for sharing your experience. It's kinda funny that the school district is going to pay no matter what because my husband works for the district where our insurance is funded and my daughter attends school there. I got a little scared because the only OT specialized in this field around here charges $400 just for the evaluation and she is not under my insurance plan. Has it been your experience that most OT's not specialized in SID can access and treat this as well as a specialized OT. I think I know the answer but right now it is costing me $40 a week to see the counselor and I just see major $$$ signs with the OT stuff :(
iVillage Member
Registered: 03-27-2003
In reply to: isherbear40
Fri, 01-07-2005 - 12:28pm

I agree Colleen, so frusterating! And I hate to sound pessimistic, but insurance companies just won't pay. My son's were diagnosed with autism, before that they wouldn't pay for speech therapy, unless they lost their speech in an accident. Then they didn't cover SI stuff. Then with autism, they don't cover it. I asked why and the lady said, "Because there is no cure for autism." Oh, I am usually a very patient person, but I got quite angry,and said, "Ah, so then you're dropping all your AIDS, diabetes, Alzheimer's and spina bifida patients too? (I'm not upset with any of these groups, just used them for illustration) Because last time I checked they were all without a cure too." She was silent for a moment. Then I said, "No, it's because they have big lobbies in Washington D.C. and you'd hate to get them mad, but autistic kids are a lot easier to bully, because it is just their tired, overwhelmed parents asking for benefits." Oh, I was so mad. Seriously, there is an epidemic of kids with autism, SI disorders, and speech delays, that with a little help could overcome these and become very much like their peers, but without a little help, parents will be overwhelmed, kids will not get all the help they need and then society will still pay the bill later on. Grrr. Ok, this stupid thing makes me mad.

But, ask your school district. Even without a diagnosis, in Utah, if they are having significant delays that would hamper their progress in schools, then they are picked up with an IEP and they can go to the preschool, get resource, etc.

Good Luck. I share your frusteration.

Rachel

iVillage Member
Registered: 11-01-2004
In reply to: isherbear40
Fri, 01-07-2005 - 12:52pm

Round and round and round we go.....


We all understand your frustrations.

               

 

iVillage Member
Registered: 01-03-2005
In reply to: isherbear40
Fri, 01-07-2005 - 1:34pm
Is SID a learning disability or a mental disorder or both? I guess I'm still really confused about all this. I just know I don't want to be in major debt by the time my kid turns 10...
:(