[parenting-over-40]

Argh! I just spent 2 months trying to get the Queen on health insurance. She was on Medicaid for the last year because of my financial situation. Fortunately, my financial situation is much better and thus the reason she is switching to health insurance. No, she doesn't qualify for CHIP either. Only problem is no matter how you code SPD, no insurance company will cover it.

Before you tell me your child can go to OT all they want, you need to know we are on an individual policy. The rules are totally different for individual policies vs working for a major corporation.

I have applied for adoption subsidy but am told that could take a year for us to get an answer. Not even guaranteed that they will say yes and/or if they will cover her bills retroactively.

By the way, the school district has turned us down for help as well.

So, any advice for me here please? ? ? ? Thank you!

[Nevada Jen]

I don't think people are going to tell you that private insurance covers OT. It usually doesn't. I had a PPO thorugh a decent sized company (500 insureds) and it only covered therapy as a result of accidents or illnesses and then a limited amount per year with a decent co-pay per session. Medicaid actually had much better coverage for therapy so if you can get nothing more than medicaid coverage through the subsidy that's what I would go with. Sorry. I know it kind of bites.

[parenting-over-40]

Thank you NevadaJen! I appreciate the empathy. This insurance does cover OT for accidents & illness. When I applied for this insurance they told me they covered OT (no exclusions) & with a $500 deductible I thought we were going to be fine. Now I find out they don't exactly cover all OT. Argh!

The OT is going to give me a discount for paying cash but going from Medicaid to paying cash is a big jump. Plus, I still have all this debt to pay off. Guess it is going to take me longer to pay off this debt than I had hoped. The Queen can't go a year without OT & I can't get a job in Corporate America with all of her special needs.

[waited2long]

Can you learn some of the easier OT exercises/techniques and do them at home? Then at least your daughter is continuing to get some of what she needs.

[shy_bear]

Don't know where you live, but go online and look for grants. I live in the Denver area and there are several grants that we found online to cover the cost of hippotherapy. Usually they are very easy to apply for and you get and answer quickly. Some of the ones we applied for were over a $1000.

[parenting-over-40]

waited - good point. We have a sensory diet. However, her OT was out this morning & we had another OT who was recommending different options. She promised to get those in writing to me.

Shybear - Great idea. Thank you! I will do a Google search for grants. What terms should I use in the search field?

[Linny]

Let me bring this up: You mentioned that the school district isn't helping you either??? I believe I'd be phoning my state special needs advocate group (their services are free----at least in my state and I've been told most states do the same)...to inquire as to what they might be able to help with to push your district into doing what's best for the Queen. I"m not as well versed with the 504.....but that's what I believe you'll need to deal with? (Someone please correct me if I'm wrong here!)

This link has a lot of info AND other helpful links that may help as well:

Sample 504 Plans - 504 Plan Templates and Suggested Accommodations


HTH.....

Sincerely,

Linny

[minibus]

DH's insurance (that the kids are on) doesn't cover OT at our preferred clinic. We paid out of pocket for an evaluation and one session. At the session, we got lots of ideas of things we could do at home. So we do DD's sensory work at home. Our plan is to go in 2-3 times a year to get them to measure her progress and give us new ideas.

Honestly, when I've been in there, the things that I see the OTs doing are mostly things I can modify and do at home. And since the OT told us that we should do these things with her several times a day, ideally every 2 hours (not realistic in our case), I don't see what doing them for an hour once a week will help.

You could also consider negotiating with the OT to see if they'd give you a discount because you have to pay out of pocket (DD's attachment therapist does this) or even if you can find one that will write it off.

Good luck!

[parenting-over-40]

Linny - Thank you! yes, the local schools turned her down a year ago. That is when behavior & sensory issues were off the charts. The Queen has calmed down considerably since then. Thus, I am guessing they would turn us down again. A friend suggested asking to transfer to a school district next to us because that school districts is one of the best in the country for special needs.

Thanks for the link to the 504. I will study up on that. Honestly, this is a full time job trying to keep up with all of her stuff. Part of the reason my financial situation got so bad was because I spent so much time on her needs I didn't have much time to run my business.

minibus - Thank you! The OT is giving me a cash discount. I worry because we have made so much progress in the last year with OT that stopping it is just going to set us back a lot. Plus, right now the Queen is way off sensory wise. So, she needs it. I can see doing the stuff at home but as a single parent there is just so much I can do. I take her to the park most days for 10-15 minutes after school. On weekends, we do a lot of sensory stuff. Our home is all about her needs.

Question - my Dad suggested writing my state representative to help speed up the subsidy thing. Has anyone ever done that?

[scandi]

Parenting --- will the OT give you a payment plan as well?? I pay out of pocket for neurofeedback for my son and they are doing a payment plan for me.

Shy Bear - I also would like to know what words you googled to look for grants -- want to send my middle child to Neurofeedback when older one is done. It has done wonders for the older... so hoping the same for middle....

[Linny]

Question - my Dad suggested writing my state representative to help speed up the subsidy thing. Has anyone ever done that?

Nope...but I would STRONGLY RECOMMEND IT!~!!!!!! It certainly can't hurt to write and ask.......I mean, the worst they can do is say, 'No'....and you're no worse off!

Sincerely,

Linny