Results 1 to 18 of 18

Thread: Speech therapy

  1. #1

    Default Speech therapy

    I am a nurse but am completely lost on this...my DD Is having speech issues and needs speech therapy. My insurance will cover speech therapy for a medical diagnosis but they will not cover speech therapy for a developmental delay. Help me come up with a medical diagnosis please!!!'n

  2. #2
    3andMe's Avatar
    3andMe is offline Every day is a gift. It's just... does it have to be a pair of socks? Hopelessly Devoted
    Join Date
    Mar 2006
    Posts
    21,515

    Default

    If we write her name three times she will come.

    Gwenn
    Gwenn
    Gwenn

    PS- How did your girls do during the school year? Did you keep them separated the whole time? Did they end up getting used to it? Did they end up enjoying school? How are you doing? We don't see you much any more around these here parts, so we have some catching up to do!


  3. #3

    Default

    Quote Originally Posted by twinmom34 View Post
    I am a nurse but am completely lost on this...my DD Is having speech issues and needs speech therapy. My insurance will cover speech therapy for a medical diagnosis but they will not cover speech therapy for a developmental delay. Help me come up with a medical diagnosis please!!!'n
    If you get her evaluated through the school district, they will provide at least 2-3 days/week of ST. She can go to her regular school and they will pull her out for ST.

  4. #4

    Default

    Easiest response first...April, my school said they will not do speech therapy until 8 y/o or 2nd grade. Pretty shocking to me but our district is in such poor shape I am seriously thinking of increasing my hours to afford private school.

  5. #5

    Default

    Lydia! Thanks for thinking about me the girls did great, they remained in separate classes which really helped Kenedee. It took almost 2 months for Kenedee to feel "comfortable" without Chyree and I almost caved on a daily basis but its probably the best thing I could've ever done for her independence. They really grew "physically & emotionally" a lot this year. We've surpassed my expectations on "surviving" the divorce. My house is soooo much better. I still get my weak moments but, we are survivors!!!!! We just got home from spending 8 days at Disney world and had a blast. While we were together 24/7 for the last 2 weeks I noticed how uncomfortable Kenedee is with her speech keeping my fingers crossed I can get some helpful info here!

  6. #6

    Default

    Quote Originally Posted by twinmom34 View Post
    Easiest response first...April, my school said they will not do speech therapy until 8 y/o or 2nd grade. Pretty shocking to me but our district is in such poor shape I am seriously thinking of increasing my hours to afford private school.
    Wow, that is shocking. Here, the school system will do evaluations starting at 3 years of age. My children who are in speech therapy have been diagnosed with apraxia which isn't considered a developmental disorder. It can be diagnosed through a speech evaluation.
    Mary Jane, doula and mom of Vada, Brynna, Tea, Moira, Kyan, Ambria, Aslan, and Anakin.
    “Be who you are and say what you feel because those who mind don't matter and those who matter don't mind.” ~ Dr. Seuss

  7. #7
    Join Date
    Nov 2007
    Location
    In my head
    Posts
    11,942

    Default

    Quote Originally Posted by 3andMe View Post
    If we write her name three times she will come.

    Gwenn
    Gwenn
    Gwenn

    PS- How did your girls do during the school year? Did you keep them separated the whole time? Did they end up getting used to it? Did they end up enjoying school? How are you doing? We don't see you much any more around these here parts, so we have some catching up to do!
    My ears are ringing. Must have heard you.

    Quote Originally Posted by twinmom34 View Post
    Easiest response first...April, my school said they will not do speech therapy until 8 y/o or 2nd grade. Pretty shocking to me but our district is in such poor shape I am seriously thinking of increasing my hours to afford private school.
    Have they actually tested her? What is the concern?
    Me (40) DH (47) & furbabies * m/c 7/08 4/12 11/12

  8. #8
    Join Date
    Oct 2006
    Location
    Toeing the edge between sanity and insanity
    Posts
    30,589

    Default

    Quote Originally Posted by MaryJane View Post
    Wow, that is shocking. Here, the school system will do evaluations starting at 3 years of age. My children who are in speech therapy have been diagnosed with apraxia which isn't considered a developmental disorder. It can be diagnosed through a speech evaluation.


    In our district-and three others around us-speech therapy cannot be provided in the school as a standalone need. If it accompanies an autism qualification or 2 other special education qualifications it's provided, but not by itself. Which totally sucks.

    Created by MyFitnessPal.com - Free Calorie Counter



  9. #9

    Default

    Wow! I have not heard of it not being provided by the school district, that is usually the reason given for insurance not covering that sort of thing. Ours is the same way, speech, certain PT or OT only covered if there is a medical dx and NOT "from birth". Ie, an accident, stroke, etc.

  10. #10

    Default

    apraxia would count. Stuttering might count. auditory processing disorder may or may not count, depending on your insurance. What is the specific issue? Can you call your ins co and get a list of medical diagnoses that they cover? It's a pretty blurry line between medical and developmental in kids. In any case, you can't come up with a medical diagnosis. Your health care provider will have to do that. And if you help them by giving them a list that would work, they will likely be willing to unless it is flat-out fraud...
    good luck!!
    (also, if you want to PM me your location I can look at the rules there. Where I am, schools have legal obligations and what they told you would totally not fly...)

  11. #11

    Default

    What I don't understand is that the only way to diagnose the type of speech delay is to do a speech evaluation. It should be easy to get your pediatrician on board to help you. Mine referred my kids early like 18 months, although after going through everything with Tea I decided to wait and go through the school system with the others. She went through 2 years of ST and OT due to her Aspergers and none of it helped her even a little bit. The evaluation through the school system was much more thorough and she made much more progress through the school based therapy programs. But I learned a hard lesson about getting the school system involved as early as possible, because once they start school the process takes forever. I do think you should look into it more with the school system, because that just doesn't seem right.
    Mary Jane, doula and mom of Vada, Brynna, Tea, Moira, Kyan, Ambria, Aslan, and Anakin.
    “Be who you are and say what you feel because those who mind don't matter and those who matter don't mind.” ~ Dr. Seuss

  12. #12
    Join Date
    Nov 2007
    Location
    In my head
    Posts
    11,942

    Default

    Quite frankly, you can't just pick a diagnosis from a list anymore than you can pick bronchitis or cerebral palsy from a list. I agree, that is fraud.

    The vast majority of childhood speech delays are considered developmental in nature and under a policy like yours, would not be covered. Certain conditions are covered (one reason so many push doctors to diagnose their children with Autism - it can be like hitting the jackpot as far as coverage for services goes). You haven't given enough information here for me to even begin to guess what the nature of her speech issue is.

    The easiest way to get speech therapy without having to pay for it is to get it through the school district. However, the caveat for that is that for the school to provide services, services must be considered educationally relevant. In other words, whatever the problem is must affect the child's access to her education. My district requires everyone to consider the following three questions when a child is being evaluated for speech therapy (which is a special education service):

    1. Is there a delay or disorder in speech/language development?
    2. Does the delay/disorder affect the child's access to education?
    3. Will the child benefit from special education?

    The answer to all three questions must be yes, or we cannot place. There are very genuine speech language disorders which a private clinic would gladly treat, but which would not receive "yes" answers to the above questions. Mild articulation delays may not impact a child's access to their education, and if the child is in the early elementary years she may not be at a point where her production of those sounds is considered outside the range of normal development. There are many SLPs who wait until the age of 8 before treating an /r/ sound. I have also been told by my administration that "We do not treat lisps in the public schools. That is for the medical model." Essentially, it is the opinion of the administration that a lisp is essentially a cosmetic problem. You could make a good argument against that, but my point here is to illustrate that the school isn't required to provide speech therapy to every single child, and that they may have reasons (supported by research) to believe it is not yet time to provide that intervention.

    In those cases, I do tell parents that they may seek private speech therapy - but often because those cases are mild, insurance won't touch them, either. Unfortunately you may need to choose between paying out of pocket, or going without services until the school feels this is something that would qualify.

    However, if the school has not actually evaluated her, you need to request an evaluation, in writing. Also submit as much evidence as you can of specifically how her speech is impacting her participation in her education. If she is unwilling to speak in front of the class, present reports, and answer the teacher's questions, her education is undeniably being impacted it will make it that much more difficult for them to deny her services. Seek an evaluation first, get a diagnosis or informed opinion from an SLP, and THEN decide how to get it funded. Don't just try to pick from a list of diagnoses and see if one of them will get her services.
    Last edited by Gwenn; 06-19-2013 at 11:27 PM.
    Me (40) DH (47) & furbabies * m/c 7/08 4/12 11/12

  13. #13
    Join Date
    Nov 2007
    Location
    In my head
    Posts
    11,942

    Default

    Any disorder/diagnosis that the insurance company would consider in a case like this would almost certainly be severe enough that the school would already be wanting to provide intervention, in my opinion. Something like Apraxia is an extremely serious (and extremely rare) speech disorder. I will qualify those kids at 2 years, 9 months if I see them that early, and they need it. A motor speech disorder stemming from something like Cerebral Palsy or Down Syndrome - again, she would already have been picked up. An Autism Spectrum Disorder - might not have been picked up yet, but you'd be worried about more than just her speech in that case. Stuttering - not sure whether or not insurance would consider that developmental. Possibly.

    I just can't imagine that if there was something out there severe enough for the insurance company to consider within their pay structure, that the school wouldn't already be willing to provide services for it anyway. So I think that route will be a dead end for you.
    Last edited by Gwenn; 06-19-2013 at 11:44 PM.
    Me (40) DH (47) & furbabies * m/c 7/08 4/12 11/12

  14. #14
    Join Date
    Dec 2005
    Location
    Ottawa, Canada
    Posts
    8,030

    Default

    Did you try googling to see if there was a city-wide program? DS1 was in our city one for free and it amazing. There was a 6 month wait, so we sent him to one privately until we were accepted... early intervention is crucial. Now no one, not even his teachers recognize that he had an issue... and at age 3 he could barely say 10 words.
    .~Becky~.



  15. #15

    Default

    I am sorry ladies I did not explain further, I was mobile and had a terrible time trying to peck out sentences one letter at a time. I have a new family doctor who although I love her dearly, just doesn't know Kenedee well enough (we have seen her once) to come up with the diagnosis necessary to satisfy my insurance company. Tapir brought up an issue so huge I felt like it slapped me in the face- I had not even considered her extensive ear issues possibly causing a hearing/auditory issue. I am going to go to the ENT and see if he will check her hearing again. She has dealt with a perforated ear drum for a little over 2 years now that doesn't seem to be closing. Sorry this seems like a huge run on but I can not get the computer to make a paragraph! I am not in any way trying to commit a fraudulent act by "making up" a diagnosis, I just did not know where to start when it came to being a medical diagnosis. Gwenn you have given me some GREAT insight! And no, she would not be a Yes to all 3 of those questions but she would be a Yes to 2 of them :/ I think I have a better grasp of this now that I have been able to read all of the responses to see what direction I need to be headed into! I really do thank you all a lot! I miss my APA but I am mobile so much I don't get to visit here as often.
    Dee Dee, Mom to 2 handsome young men & 2 beautiful girls!

  16. #16
    Join Date
    Nov 2007
    Location
    In my head
    Posts
    11,942

    Default

    Quote Originally Posted by twinmom34 View Post
    I have a new family doctor who although I love her dearly, just doesn't know Kenedee well enough (we have seen her once) to come up with the diagnosis necessary to satisfy my insurance company.
    Like you said, take her to the ENT and have her hearing checked out (and possibly her tonsils and adenoids, too, depending on what the issue is). Then take her to an SLP and have a speech-language evaluation done. Between the pediatrician, the ENT and/or the audiologist, and the SLP - I promise you, one of those people will give her a diagnosis of something if she has an issue serious enough for insurance to cover her speech therapy. The other person would be a neurologist but I would hope if there were a neurological issue, your pedi would have already made a referral. If none of those professionals have a diagnosis for you that will satisfy the insurance company, you will be one of the vast majority of cases where you won't fall under the umbrella of insurance coverage. Good luck - going about it the other way is backwards.
    Me (40) DH (47) & furbabies * m/c 7/08 4/12 11/12

  17. #17

    Default

    All of mine had to be evaluated first by an ENT for hearing issues. That's generally the first place they look.
    Mary Jane, doula and mom of Vada, Brynna, Tea, Moira, Kyan, Ambria, Aslan, and Anakin.
    “Be who you are and say what you feel because those who mind don't matter and those who matter don't mind.” ~ Dr. Seuss

  18. #18

    Default

    Gwenn, I guess I keep only telling parts of the story. She had her tonsils and adenoids removed in 2009. She a little young for adenoids at the time but they were removed due to causing sleep apnea.
    Dee Dee, Mom to 2 handsome young men & 2 beautiful girls!

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •