Let me just start by saying that this blog post is not to bash our insurance company. In fact, you will rarely hear me speak in a negative way about our insurance company because of the incredible coverage that we have and the benefits that our company provides.
I have learned that most families that have their children in regular speech therapy run into some trouble with getting insurance to cover these necessary therapy sessions. In fact, when we started the process of getting Benjamin to see a speech therapist, we found an entire page on her website that contains tips for getting speech therapy covered by insurance.
The response that we were getting from our insurance provider was that speech therapy is not covered for “developmental delays.” I tried to explain to the insurance company that Childhood Apraxia of Speech is not a developmental delay. It is a neurologic and organic condition and that speech therapy almost takes on the feel of physical therapy as we work with Benjamin trying to train the muscles that control mouth to produce intelligible vocabulary. The thing that really did not make sense to me was that if I stepped out onto the street and was hit by a car and lost the ability to speak, my speech therapy would be covered – but my son who was struggling to begin to speak would not be covered.
The best piece of advice that I can give you is to make friends with all of your providers. They are incredible resources, wanting to see your children succeed and will help you in everyway that they can – including insurance topics. In all of my online searches, I also stumbled on a contact at the American Speech and Hearing Association that is an advocate for patients. I reached out to her and she shared an incredible packet of information that contained articles, tips, and sample letters for appealing denied insurance claims. Download the Pediatric Verbal Apraxia Info Packet here.
After getting the packet, a letter of medical necessity from Benjamin’s neurologist, and reports from all of Benjamin’s therapists, I submitted our appeal. I am excited to tell you that after several months of review, Benjamin’s speech therapy will now be covered by insurance and that will be retroactive to the claims that we paid out of pocket over the last year. They are not paying it at 100%, but we will take all of the help that we can get – and if we never got insurance to cover his therapy, that would not have stopped us from perusing all of the specialists that we have seen. I would dig ditches to make sure that he got everything that he needs for his speech success because I’m his dad – and that’s what dads do for their kids.
Source: Searching For Speech