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Old 08-19-2009, 11:15 AM
 
Location: Edison, NJ
28 posts, read 103,914 times
Reputation: 14

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Hi everyone,
I am not sure where to post this so I post it here. If it is not the right place please move it. I am experiencing problems with my insurance company to get simple service such as OT or PT for my son who is diagnosis with Pdd-Nos. Even through, they approve the initial evaluation and approval for service, they are only approving for one visit where our insurance benefits states that I am allowed 30 visit per year combined. Is all insurance company have the same problem. Thanks
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Old 08-19-2009, 12:44 PM
 
Location: Bellingham, Wa
63 posts, read 222,903 times
Reputation: 32
Make sure that the initial evaluation from the OT states that he needs a certain amount of visits or progress until he no longer needs this service. It is common that ins companies try not to pay for services for our children. If all your paperwork is in line call the ins company for an explanation. You may need to get your HR person to call them about this issue. If you don't have an HR person to call then call the ins co yourself. If the person you get does not give you the answer you want then ask for their supervisor. You may have to go through a few people but if your ins should cover the ins you may need to make them do it. You may have a bit of a fight on your hands but it will be worth it when he makes progress.
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Old 08-22-2009, 06:45 PM
 
999 posts, read 4,254,410 times
Reputation: 363
How old is the child? Under 3 yrs old then early intervention in your state should provide these services, over 3 yrs then they should be covered by the school, still take as many as you can get through insurance, even if it's only once a month in addition to the school services. This is typical of insurance, they will not pay to get a person to do something they have never done, they will pay to fix something that was lost, ie speech or mobility lost due to an accident, not speech or mobility that never developed properly.
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Old 09-03-2009, 08:32 AM
 
Location: Edison, NJ
28 posts, read 103,914 times
Reputation: 14
He is currently 5. We been told that there is a difference between OT and PT from the school and those services medically, and he would benefit more from medically than from school. I am not sure about that. Can anyone tell me if it is better do it medically??
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Old 09-23-2009, 06:31 PM
 
1,312 posts, read 4,280,781 times
Reputation: 1977
I think the only difference is that the school pays for in-school services, or you pay to go to a private place. I'm certainly not an expert, though. I recommend calling a private provider and asking them the difference.
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Old 09-25-2009, 12:44 AM
 
7 posts, read 11,510 times
Reputation: 11
If your child needsPT and OT the state offers programs for children with developmental delays .. I know the one in FL is called Early Steps age range is 0-3 years .. He gets SSI for his disabilities and with that they put him on CMS...
I used to process claims and appeals for insurnaces, u will have to fight if they are giving you problems. It is all based if its medically needed. Allot of times they won't approve anymore visit until they get report back from therapist.
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Old 09-25-2009, 08:11 AM
 
Location: Edison, NJ
28 posts, read 103,914 times
Reputation: 14
Thanks for everyone's advice. We had hard time with the insurance company. They told us that he will receive service until certain date but denied our evaluation claims and stated that all claims are up for review , so we aren't sure if we can afford them on our own. It is currently in appeal process.
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Old 09-25-2009, 03:08 PM
 
Location: Honolulu
263 posts, read 777,022 times
Reputation: 199
Quote:
Originally Posted by noyha View Post
Hi everyone,
I am not sure where to post this so I post it here. If it is not the right place please move it. I am experiencing problems with my insurance company to get simple service such as OT or PT for my son who is diagnosis with Pdd-Nos. Even through, they approve the initial evaluation and approval for service, they are only approving for one visit where our insurance benefits states that I am allowed 30 visit per year combined. Is all insurance company have the same problem. Thanks
That's a shame. I hope you win in the appeal. Isn't NJ one of the states where insurance coverage for treatments for autism (ABA, OT, PT, speech, etc.) are supposed to be covered by insurance companies?
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Old 09-25-2009, 03:16 PM
 
Location: Edison, NJ
28 posts, read 103,914 times
Reputation: 14
Quote:
Originally Posted by Afishwithabike View Post
That's a shame. I hope you win in the appeal. Isn't NJ one of the states where insurance coverage for treatments for autism (ABA, OT, PT, speech, etc.) are supposed to be covered by insurance companies?
Yes, but right know, they refused for unknown reason. Something between the insurance and where my son gets services. So I wait until all cleared...
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