Therapy

[Name witheld]

I have just a quick question. How are you able to continue therapy if the therapist cannot note any progress? Do you have to have progress to continue therapy? Or can it be just to maintain the level they are at? Well, as you can see still fighting the therapy battle. Thanks

[Alice]

My insurance co gives a specific amount of time to work on a specific problem. Lets say 6 months at 2xs a week and when that is done my therapist will write down we are having another (different) problem that needs to be worked on and then we get another time frame for that. I have found its like a game with the insurance co. My insurance co has stated they DO NOT allow for "maintenance" therapy. Whatever!!! Good Luck to you.

[m&mmom]

Our therapist notes problems needed to work on every six months and submits it for apporval to the insurance company. We're allowed 15 visits per year and anything more than that requires a written treatment plan.

[francine]

To name withheld.....

I don't know how old your child is but there are a couple more options....

therapy through the state - Early Intervention
this is a way to get weekly OT & PT
every state has different rules however

Also - some states will give you a secondary insurance plan to cover whatever the primary one doesn't (for therapy). We have that here in PA - it is under the Medicaid system - our children are consdiered loophole children.

Check out this site www.nichcy.org- it'll give you information for your state.

When I brought Maia to therapy today there was a meeting going on one foot away from the waiting area. I overhead them discussing new insurance laws in this area..... that even if you change the diagnosis- if they are related in the least bit, it will be denied.

Also - some insurance companies let you appeal and allow you more time.

Try all avenues.

Good luck,
francine

[Brenda]

We didn't have problems with being allowed to go to pt, but rather we had a 'cap' on the total amount we could spend per calendar year. Of course, my daughter, now only 7 months, used her's up about 2 months ago.

We got around this by contacting the medical review board. Every insurance co has one so I'm told. After we got their faxes and phone #'s, I asked TCH BPI doctors, her local pediatric dr, and her pt's all to write letters to the insurance medical review board. In their letters they explained my daughter's injuries and that if pt was not continued and she would lose all use of her arm.

Within 2 weeks of the insurance company receiving the letters, my daughter's insurance coverage for therapy went from 1,500. per year to 30,000.

And all I had to do was make phone calls and ask. TCH faxed their letter within 3 days to my insurance co as well as everyone else.

I hope my story helps you. My advice is to not take no for an answer. If you don't feel comfortable standing up to all the 'big guys' ask someone to help you. Here in WA state, each county's health department has a person, who is also a nurse, that will do all of the 'fighting' so to speak for you, or get answers for you. They usually know more about insurance than anyone.

Good Luck!

[Name witheld]

Thank you so much, your replies have helped alot. My daughter is 3 and has Medicaid but I'm not sure how they deal with things. In this case it's actually the therapist denying therapy instead of an insurance company. I have found a new therapist now and we're trying to get that set up. So hopefully all will work out soon. thanks