Insurance Coverage - So Intimidating

It’s incredibly depressing. I looked up whether speech therapy is covered by our insurance policy. Essentially the answer is not unless your child has speech and then loses it due to head injury or stroke. They don’t cover developmental delays.

My understanding after doing a bit of research is that I can appeal that. I can argue that Ava does not have a developmental delay. A developmental delay implies that if left alone, she’ll eventually catch up on her own. That is definitely not the case. Ava has a neurological speech disorder. She will only catch up if she has intensive, specific types of therapy.

I’ve read that if you make the right kind of appeals with the appropriate insurance diagnostic codes (neurological disorder, lack of muscle coordination problem, etc.) and you have a lot of persistence and luck you can get some insurance coverage. To be honest, I read a little bit about the process, I get discouraged, and I promise myself I’ll look at it again next week. Well, that was three months ago.

This therapy stuff is expensive and it is putting a significant strain on our family’s budget. I’m already having to fight balancing budget needs with Ava’s need for intensive therapy. I think to myself, “Does she really need to see Ms. E twice a week, or would once a week be enough?” The real answer is that she definitely needs twice a week. Three times would be even better. I hate letting money dictate my decisions about what is best for my daughter, but that is a practical reality.

Having some insurance coverage would make a huge difference, but I don’t know where to start. I’m paying two different therapists out of pocket. Neither therapist submits to insurance for you. I don’t even know how to do it myself. I guess I need to find out. I understand that the appeals process can take months, so I suppose I should get started soon.