Thursday, June 18, 2009

Bite the bullet

Today I made a phone call to nail down some information that I have needed for a while. Needless to say, I am not pleased with the information that I received. My oldest, Allison, has a speech delay. We first had her evaluated at the tender age of 15 months, because it seemed as if we were regressing. We heard "mama" and "dada", and then those slowly disappeared. She would point and say "uh" to make her wishes known. No matter how much we tried to encourage her, we got nowhere. So, the pathologist suggested therapy. We wondered how the heck that was going to work with an 18 month old (several months had passed with us on the waiting list).

We went, we tried, we thought it was lame. No offense to speech pathologists out there, but it was the same stuff I was doing at home. Plus, she freaked out for the first ten minutes of each session even with me in the room. We originally received a denial from our insurance, which meant we were looking at $150 a session. Guess how long a session is? 50 minutes or so. Outrageous! And to go once a week for who knows how long??? Children's sent the paperwork in, and the insurance company actually covered it, and we only paid our $30 copay for the 3 sessions we went to. But even $30 a week seemed like a lot for one hour of "therapy", that was similar to the activities I did with Ally.

We evaluated our options, and Ally being an only child at that point, we thought that social interaction would prove helpful. We enrolled Ally in a local daycare for 2 mornings a week, so that she could see, play with and hear other kids. It took a while to hear any differences, but I'm sure that the socialization helped immensely. Over the past few years, her speech has taken off, with huge gains. However, there are still major problems. We wound up having her evaluated last spring. Again, therapy was recommended because she tested well below her age range. I was 5 months pregnant or so, and knew that whenever the spot would become available, I would have a newborn to tote as well.

We pursued the whole insurance thing AGAIN, to be told, AGAIN, that it was denied. Here is the kicker: our insurance will only cover speech therapy if it something that you had and then lost. For instance, if I had an accident or stroke, then it would cover rehabilitative speech therapy for me. But it will NOT cover my child to get the (IMO) necessary help. We pulled out Mike's policy and began to examine it thoroughly. Want to know what our insurance will cover? Abortion. I don't want to get into the Roe v. Wade debate, but it surprises and angers me that the policy covers such a procedure for an office co-pay (and I believe it makes no restrictions on it) while denying my child therapy that could dramatically help her in school. I'm not asking to send her to special "intelligence enhancing" classes or anything else.

But I'm her mom, and I still don't understand all that she says. Strangers understand maybe half of what she says. It is far beyond the normal toddler/preschooler speech issues.

With the birth of Kelly, we never found the time to take Ally for therapy. Once things settled down, I called to schedule. Big surprise--it had been a year, so we had to have her evaluated for a third time. Yet another big surprise--she still needed therapy, even though she is so much better than she was before. In fact, she scored above average in intelligence; but well below in actual articulation. The report says she has a "severe articulation disorder".

But once again, insurance has denied it. The therapist had mentioned a grant that Children's had received, to help in situations like ours. When I called to see where we were on the waiting list, I was informed that money was used immediately and the therapist should never have mentioned it. I was pretty upset, because we were really hopeful that could help with the cost. I don't know if we are looking at 5, 10 or more sessions at today's price of $170-180 a session. With Mike having to take a pay cut and the added expense of another child, it is going to be a huge hit to our budget. Don't get me wrong, we will do whatever we need to for her well-being and education. But I think that insurance should cover at least part of it. We are calling today to pay and schedule her therapy. I just hope it works!

1 comment:

Kelsey said...

Sara - I'm light years behind on all things blog related...

I just saw this post. In our county we have a service called "Help Me Grow" which helps get access for people whose children have any type of delay - then at age 3 the school system takes over. You SHOULD be able to get into a special preschool program in your local school or county which would include some degree of speech services. Certainly Ally would qualify when she heads to K but sooner is always better if possible. I'm surprised your ped. hasn't helped out more w/ this - does he/she know the trouble you're having w/ insurance?

I don't know if we could even pay a 30$ copay for weekly therapy, so I would be pursuing my options like crazy.

Sorry to be so long-winded - I hope you guys find a way to work everything out!