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

(minimum 6 characters)

Insurance doesn't cover this?!

Posted by on Sep. 28, 2010 at 9:49 AM
  • 31 Replies

My DS has an appt for a speech evaluation on 10/12 so I called the insurance company to make sure that they cover it and THEY DON'T!  I am just starting to pay off the medical bills from when he was born almost 3 years ago (and I had insurance).  I feel horrible for even thinking about the issue of money when my son really needs this, and I'm still going to take him, but I'm just so upset right now.  I wish there was some alternative for this.  I guess I'll have to research more.  I just can't believe this.  I would consider this medically necessary.  Its for a child's development and requires a prescription!

 

 

CafeMom Tickers
by on Sep. 28, 2010 at 9:49 AM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-10):
melindabelcher
by Member on Sep. 28, 2010 at 9:51 AM

Wow thats tough. I'm sorry your going through that. My son and daughter were both in early intervention one was launguage and safety the other was for language and poor weight gain, and insurance covered everything i didn't have a co-pay or anything. Did you ask if there was a way to get it covered. IE: prior authorization, a specific program.

MylifeMylove23
by on Sep. 28, 2010 at 9:51 AM
Most states have programs if insurance doesn't cover speech. Ours didn't either and we were happy because he got better speech else where. Under 3 in CA its called alta regional after 3 you go through school districts.
Posted on CafeMom Mobile
LyTe684
by on Sep. 28, 2010 at 9:55 AM

This. Also, a prescription means nothing as far as health insurance, unfortunately. Just glad that you called ahead of time instead of getting that surprise after or during the visit. GL!

Quoting MylifeMylove23:

Most states have programs if insurance doesn't cover speech. Ours didn't either and we were happy because he got better speech else where. Under 3 in CA its called alta regional after 3 you go through school districts.


mommy11260
by on Sep. 28, 2010 at 10:02 AM

I would talk directly to my insurance company, ask them if it is covered if you can prove it is medically necessary.  A lot of times, if a Doctor will contact your insurance company, and explain to them why it is medically necessary, it will be covered under the policy.

 

alliesmom112
by on Sep. 28, 2010 at 10:08 AM

That really stinks. Where do you live? DD just had to have a speech eval but we didn't have to pay for it. The is a program here called Early Intervention that receives it funding from the state. They even came out to the house to evaluate here in own environment so that she would be mor ecomfortable.

Seans_mommy123
by on Sep. 28, 2010 at 10:38 AM

You can have your child evaluated by your local school district. If the speech issue is bad enough he will receive servies through the school district at no cost to you.

Scuba
by on Sep. 28, 2010 at 10:46 AM

Going through the schools is a great option (if your son is old enough). Sometimes doctors can also code things differently so insurance will cover it. (We had an issue with my DS's physical therapy after he broke his leg - one code wasn't covered, another one was - and they both meant the same thing.)

ddhb2007
by on Sep. 28, 2010 at 11:11 AM

Have you checked with your school to see if they provide services?

Mipsy
by on Sep. 28, 2010 at 12:04 PM

 Can't you go through early intervention instead?

teri4lance
by on Sep. 28, 2010 at 12:05 PM

you should have a speech program thru your state. call your local elementary school or your pedi. they should be able to put you in touch., the programs are usually free or based on ability to pay. 

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)