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Autism - Support Across the Spectrum Autism - Support Across the Spectrum

does insurance pay for

Posted by on Jul. 16, 2012 at 1:43 AM
  • 12 Replies
Ot? We are finally starting to get some answers about my son. The urologist sent him to a physical therapist who truly listened and cared. She is just pediatric and sees a lot of kids like him. Nobody else ive talked to has ever heard of a kid like him! In fact she sees so many kids whose parents are struggling to get help she went the extra mile to learn about all of this stuff.
So she says he isn't picking up on the cues from his body. So his body says "I have to lee" but his brain doesn't get it. His body says "I'm hungry" and his brain doesn't get it. This explains stuff all of the way back to 1 year old when he first started eating so much he would get massive stomachaches. It explains why hes suddenly starving everytime he gets in the car even after a huge meal. It explains why he can complain of being cold at 80 degrees and hot at 60 degrees. And it explains when he has an asthma attack he never complains of not being able to breathe. Instead its something like he cant sleep.
she says he has sensory issues for sure (duh) and I need to push for ot. She also wants to see him have a full psychological workup. He also needs speech therapy (duh again)
She says that with ot and pt working together they can teach him how to understand his body's cues. From there we will go to holding his urine for longer periods of time.
he goes to behavioral health the 24th. But does insurance cover ot?? I know it covers pt and speech is provided by the school.
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by on Jul. 16, 2012 at 1:43 AM
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Replies (1-10):
3mx2mom
by on Jul. 16, 2012 at 7:10 AM

Most insurance does cover OT, but it may depend on the diagnosis.

justfiveofus
by on Jul. 16, 2012 at 8:24 AM

Most insurances in the US won't cover anything with an autism diagnosis, if it's another diagnosis a lot of times it's covered.  I would call your insurance company and ask them.  I've called ours and they are really good about letting us know what's covered and what's not. 

Your son sounds a lot like my son!  Maybe check with his school to see if they provide ot because our school does. 

arkansasmama08
by Silver Member on Jul. 16, 2012 at 8:41 AM
It depends where you live and who your insurance is through. Ours only covers 20 visits a year. When we go once a week for one kid and twice for the other, it doesn't help. How old is he? You could go through Early Intervention or the school system and get help through them. That's what we're having to do. We're also applying for TEFRA because we're over income for ssi and Medicaid but certainly can't afford therapies by ourselves. Between the 2 kids it would cost close to $400/week for pt and it
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RockinMama0608
by on Jul. 16, 2012 at 9:34 AM

Our insurance will cover OT, PT, and ST only if he is not already receiving therapies through the school.  For example, during the school year, if we want to seek additional therapies we must pay for the services.  But, during the summer when he is not in school, the insurance will cover the therapies. 

I would call your insurance company to make sure (they may have limitation to how many visits your child can have with an OT). 

JasonsMom2007
by on Jul. 16, 2012 at 10:43 AM
He just turned 5. My sil would know if the school he is entering provides ot because she works there. Thanks.


Quoting arkansasmama08:

It depends where you live and who your insurance is through. Ours only covers 20 visits a year. When we go once a week for one kid and twice for the other, it doesn't help. How old is he? You could go through Early Intervention or the school system and get help through them. That's what we're having to do. We're also applying for TEFRA because we're over income for ssi and Medicaid but certainly can't afford therapies by ourselves. Between the 2 kids it would cost close to $400/week for pt and it

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badgermom2012
by on Jul. 16, 2012 at 10:49 AM

It really depends on your insurance, what state you're in, etc.  I recommend you look into the specifics of your policy and what's available in your area.  

mallowcup17
by on Jul. 16, 2012 at 10:51 AM

it depends where you are, the kind of insurance you have and other factors. ours does but only so many visits a year but thankfully she gets that stuff in school so we use little or none of that allowed by insurance...

JasonsMom2007
by on Jul. 16, 2012 at 1:24 PM

Well, I messaged my SIL and she said they don't have an OT on payroll but if he needs one they will be required to pay for the service and find him one.  He is going to go to a charter homeschool program.  I don't think she is so happy because she will have to figure out how to pay for it (she is the financial department there) but hey, it's help!

Leobaby2007
by on Jul. 16, 2012 at 11:16 PM
Yes- 60 sessions per calendar year and I have a $50 co pay, but the sessions are $200 plus, so insurance picks up the rest. It's not great, but better than nothing.

Also, I didn't need for my son to have an autism dx to get this- just had to prove through an evaluation that he had find motor delays.

However- although my insurance will pick up partial cost of speech evaluations ($50 copay again), they will not help out with the actual cost of speech therapy unless there was a brain injury or stroke. It makes absolutely no sense.
TristansMom440
by on Jul. 17, 2012 at 10:17 AM

This is true!  The codes have to be something else....ie:  when my son's dr wanted him to have allergy testing, she put something like "child w/ speech delay" or something like that b/c if she put the "a" word, it would not have been covered.  :-/

Quoting justfiveofus:

Most insurances in the US won't cover anything with an autism diagnosis, if it's another diagnosis a lot of times it's covered.  I would call your insurance company and ask them.  I've called ours and they are really good about letting us know what's covered and what's not. 

Your son sounds a lot like my son!  Maybe check with his school to see if they provide ot because our school does. 


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