Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

When does insurance cover .......

Posted by on Dec. 12, 2014 at 9:42 PM
  • 13 Replies

pull-ups????

My daughter is 3 1/2 but she's big for her age. She's in the 4T/5T pull-ups and it looks like one more growth spurt and those won't fit anymore. (I've seen 5 year olds and my daughter is the same size as half of them). While I have been working on potty training with her and would love to get her potty-trained, I don't really think it's going to be anytime soon. Her school also feels she shows no readiness signs for potty-training, and always makes up wet.

So do you think insurance would start covering pull-ups at this point? If so, should I just call her pedi about getting a prescription and do all insurance cover this, or only some types?

by on Dec. 12, 2014 at 9:42 PM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-10):
dawncs
by Dawn on Dec. 12, 2014 at 9:45 PM

It really depends on the state and if it is private insurance with the company being the insurance company or regular insurance. The rules are different for private insurance. There is good information on it at www.autismspeaks.org. I also recommend at least signing up for the Autism waiver in your state for your daughter.

Dawn
Asperger Syndrome Published Author
Asperger Syndrome diagnosed May 1997 as an adult
Inherited genetic Metabolic Syndrome diagnosed August 2014 (maternal side)
My Author Page

ineedcoffeemom
by Brittaney on Dec. 12, 2014 at 10:03 PM

I live in Texas and there is no autism waiver here. There are two waivers she may qualify for and we're on the waiting list for both. Unfortunately Texas does not provide near the services to meet the demand and our current waiting time is 11 YEARS.  I'll check autismspeaks website to see what info they have on this.

Quoting dawncs:

It really depends on the state and if it is private insurance with the company being the insurance company or regular insurance. The rules are different for private insurance. There is good information on it at www.autismspeaks.org. I also recommend at least signing up for the Autism waiver in your state for your daughter.


dawncs
by Dawn on Dec. 12, 2014 at 10:11 PM

It is one of the things that I hate how the states treat the disabled at times. They would probably get more in taxes by providing the right services to certain disabilities than being more dependent than some are these days. I get frustrated with the regulations and limitations at times myself.

Dawn
Asperger Syndrome Published Author
Asperger Syndrome diagnosed May 1997 as an adult
Inherited genetic Metabolic Syndrome diagnosed August 2014 (maternal side)
My Author Page

Nickmom1118
by Nicole on Dec. 12, 2014 at 10:45 PM

I thought there was a post about this same thing not too long ago. If I remember from that post, they said that you should get a perscription from your pedi, and then give the perscription to a specialty pharmacy.

Hope someone else can give you more info. Sry if my information isn't all correct.

Momof4AEMW
by Platinum Member on Dec. 12, 2014 at 10:59 PM

Our regular insurance did not.  Medicaid did after age four.  I'm sure each state and insurance are different.  I would just call and ask.

N.Carter2001
by Bronze Member on Dec. 13, 2014 at 12:17 AM

My son is 6 years old. He is on medicaid and we got a prescription but after a few months they would not pay. They said it was not a need and yes this was medicaid.  He has autism and in a wheelchair.  And he dont notice when he goes.

mypbandj
by Jen on Dec. 13, 2014 at 12:22 AM
I'd start asking now so you can figure out what you need to do. I would think it would have more to do with her size than her age.
Posted on CafeMom Mobile
ineedcoffeemom
by Brittaney on Dec. 13, 2014 at 7:58 AM

I'm so sorry medicaid is treating you like this. I was looking up websites to get more info and came across this one

http://www.savingcase.com/index.php/2011/09/12/got-diapers-diaper-coverageby-insurance/

It says Medicaid HAS to pay, even if they tell you otherwise. I hope this can help you get it figured out.

I have private insurance so I guess I'll just have to call the insurance company to find out .... I just know that since's it's private, it might be one of those things they can decide for themselves whether to pay or not.

Quoting N.Carter2001:

My son is 6 years old. He is on medicaid and we got a prescription but after a few months they would not pay. They said it was not a need and yes this was medicaid.  He has autism and in a wheelchair.  And he dont notice when he goes.


N.Carter2001
by Bronze Member on Dec. 13, 2014 at 9:04 AM

 Thanks for info.

Quoting ineedcoffeemom:

I'm so sorry medicaid is treating you like this. I was looking up websites to get more info and came across this one

http://www.savingcase.com/index.php/2011/09/12/got-diapers-diaper-coverageby-insurance/

It says Medicaid HAS to pay, even if they tell you otherwise. I hope this can help you get it figured out.

I have private insurance so I guess I'll just have to call the insurance company to find out .... I just know that since's it's private, it might be one of those things they can decide for themselves whether to pay or not.

Quoting N.Carter2001:

My son is 6 years old. He is on medicaid and we got a prescription but after a few months they would not pay. They said it was not a need and yes this was medicaid.  He has autism and in a wheelchair.  And he dont notice when he goes.

 

 

Charizma77
by Carissa on Dec. 13, 2014 at 9:36 AM

I never looked into it with Ashton.he wasnt fully trained until 5 and was still in a size 5 diaper because he was so tiny..but I did have people mention I could get diapers for him for free. My friend did that with her little girl with Down Syndrome.i believe the girl was 4 or 5 and she had got the diapers delivered to her house..she got a certain amount for free and what she needed after that she bought..it was a huge help to her though, I don't think her daugher was trained before age 7. 

Add your quick reply below:
You must be a member to reply to this post.
Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)