I’ll tell you how terrible.  I logged in probably 15 hours in the past 3 days just trying to get coverage for speech therapy in 2014.  It’s March.  That means that we’ve had close to 10 sessions already as Luke goes each Monday.

He has private OT and Speech, and it’s been several months where we’ve had no problem.  Since my insurance company takes ages to get around to letting you know you’re not covered, I just found this out recently.  I’ve spoken to 5 reps this week alone and 4 of the 5 have been extremely unhelpful, ignorant to what their own company offers, or have acted annoyed with me.  Oh, I’m sorry to bother you.

I first called and was told that they don’t cover learning disabilities.  Luke doesn’t have a learning disability.  I was then told they don’t cover “just a speech delay”.  Ok, my son is almost 2.5 and says zero words BUT used to say 10 words.  That’s a speech regression, which is listed as being covered in your clinical policy bulletin 0648 that you can’t find on your own website.

I was told to have my provider resubmit everything under a different code, provided did, denied again.  Called back the next day, same thing.  Called back the next day, same thing.

Today I called and finally talked to a somewhat helpful rep that said our provider can send a medical necessity letter which will be “considered” for future visits.  The appeal for the previous visits will be decided within 30 days.

What does this mean?  That my son will not have his private speech therapy for at least a month.  I’m sure longer, if ever again.  If the previous visits are denied, I’m looking at $2000 out of pocket, and that’s just for the past couple months.  We wouldn’t be able to afford future visits, sadly.

We have at home Early Intervention and to be completely honest, he does a lot better with his home speech therapist.  He turns 3 in early October so once that happens, Early Intervention is over.  That leaves 3 months with no speech therapy, potentially.

Unless he’s diagnosed with autism or another recognized neuro disorder, he will probably not be covered.  The wait list for the developmental pediatrician who would diagnosis him is 6 months. Some days I think he may have ASD (Autism Spectrum Disorder), some days I think not.  I know that there has been specific findings recently regarding SPD being its own disorder and it’s “in progress” but I challenge the people who make this decision to live with a kid with SPD for a week.  Then tell me it’s not a disorder.

My health insurance is $400 more a month than it was in 2013 and I have less coverage.  Makes a whole bunch of sense….