by Tara, Contributing Writer
So many sacrifices.
That’s what I’ve learned much of this journey with apraxia is all about.
Also the dreaded word: INSURANCE.
Oh yes, the stories I have about dealing with insurance when it comes to speech and occupational therapy.
Our insurance through my husband’s work is actually very good overall. EXCEPT for speech and occupational therapy.
They have a yearly maximum. Only 30 speech therapy sessions covered per year. That’s it. No more. They don’t care what the diagnosis is.
30. That’s all you get. (Same for occupational therapy).
Who picks that random number?!? 30. Some person sitting in a meeting room … “Hey 30 speech sessions for a child sounds like more than enough. Who needs more that?”
That doesn’t even come out to 1 speech session a year for the 52 weeks in a year!
Kids with apraxia need AT LEAST 3 to 4 sessions a week.
We’ve tried begging my husband’s HR department. We’ve tried appeals directly through the insurance company. We’ve tried having our SLP and OT call the insurance companies themselves to plead our case. Nothing. Nada. Zip. Only 30 per year.
So, after the 30 ran out last year we paid out of pocket for a couple months (a straight $100 per hour of speech therapy and a little more for OT).
That sure adds up quickly. We cancelled cable. Stopped eating out. Went down to one car for a while (my husband can take a bus from our neighborhood to his office). Started shopping at second-hand stores.
Our son was making so much progress there was no way we were going to stop treatment.
After more hours of researching we made the decision to buy our son a separate insurance policy. With recent changes to health care laws, we were able to “shop around” and find a plan that offered coverage of UNLIMITED speech and occupational therapy sessions per year.
We priced out what it would cost to continue paying a straight hourly fee versus buying a separate insurance plan and the insurance plan won. Yes, that meant another monthly premium, another deductible, etc. BUT it still financially was less than paying straight out of pocket.
So, we dropped our son from my husband’s plan through work and got him his own.
BEST DECISION WE’VE MADE!
Yes, it’s still a financial strain on our family, but we can stay with the therapists our little boy loves and we don’t have to count sessions or worry about “maxing out” every year. Right now, he’s in speech 4 times a week along with occupational therapy 4 times a week.
Just add it to the list of things I never imagined I would have to know or learn about. Thank goodness I have though.
Apraxia is full of roadblocks, challenges, uphill battles and more roadblocks. The key is finding ways to get around those roadblocks. Even if it means sacrificing. Even if it means staying up all night staring at numbers and dollar signs on a piece of paper until your head spins. Even if it means going without certain “things” for a while.
Bio: Tara is the extremely proud mom of two kids who could both put the Energizer Bunny to shame. She spends her days chasing, running, chauffeuring, refereeing, counseling, scheduling, coaching, doting, teaching, cooking, playing and loving. Her little boy and girl are diagnosed with apraxia. She lives in Minneapolis and is “temporarily retired” from her days as a TV/Radio journalist until her kids are a bit older.