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.
21 thoughts on “If There’s A Will, There’s A Way … Getting Unlimited Apraxia Therapy Sessions”
This is the first I heard of an insurance that does unlimited speech and OT. Could you email me the name of it if we ever need it? Thanks. email@example.com
I would love to hear more about this as we just ran into insurance problems (6 years into our apraxia journey). Thanks!
Unlimited therapy would help my family in amazing ways any additional information would be wonderful!
Hi Jami ! Email me at firstname.lastname@example.org and I’d be happy to help any possible way I can!! Look forward to hearing from you!
Absolutely! Will email you right now!!! 🙂
I’d love to know what insurance you have for your child as well. We have been paying out of pocket from the beginning of our journey which started to an a half years ago.
I have to say that your post today couldn’t be more fitting. My husband and I sat last night discussing the sacrifices we make….the battles we have won and have lost to insurance companies….how far our son has come and the road ahead for our 3.5yr old son. I am also curious the name of the insurance company that was a good fit for you, could you also send me an email? Thanks for sharing.
We live in PA and had the same problem with only 27 approved sessions. However, in PA, our daughter qualified for medical assistance through the state. She is considered a child with a disability therefore she is counted as an individual and our family income is not counted for her eligibility. Her diagnosis is apraxia and has no other conditions.
Would love to know what plan you choose? Did you go with the market place. I only saw 90 visits a year and not unlimited. Do share, please!
Holy moly thank you! We are currently dealing with this right now. We discovered our insurance covers 60 visits a year, which only covers 12 weeks of our year We have been struggling trying to figure out what we will do. I would love to know the insurance you used as well. Can we email you for more info?! Thank you thank you!!!
Wow! That is awesome. Could you email me the info as well? We just found out yesterday our ot therapy was doubling in price. For 1x a week it will be almost $1000 a month. That’s with our ins. We were heartbroken. Thank you.
Great idea, my current insurance has zero coverage. Would you mind emailing me the name please? Marcchisholmwgu@gmail.com
Wow, what a wonderful post. That would be awesome for our kiddo and our budget! Can you send me the info too, please? Thanks so much! 🙂
Please please email me with what insurance plan this is! I’ll buy it tonight!
I hope everyone who has commented can see my reply … PLEASE email me at email@example.com and I’d be happy to share the specifics of our plan and answers any other questions I can 🙂 Tara
I would love to know more information about this. We are already hitting road blocks for more therapy. Aliciaaugustine@ymail.com
So the appeals don’t work,I’m going to be up against that, I need to know the insurance plan you had also.
THis is wonderful news. I just started looking into what to do. ours is 90 visits per year for both ot and ST. Can you please send me the name of the insurance company as well. Thank you so much!.
Hi. I know this is a fairly old post, but if you could share information regarding the insurance company you are using, and whether the speech therapy is still covered, it would be very helpful. Email is firstname.lastname@example.org