Insurance won't pay

[?] Subscribe To This Site

Insurance won't pay

by Gina
(Massachusetts)

I finally got my insurance to pay for the evaluation but may not cover treatment because they don't cover sensory integration dysfunction. This really gets me mad because if OT can help why won't they give it to him? My son also has mild low muscle tone. Do you think he might be able to get help for that??? I am trying to figure out how I can still manage getting him treatment somehow but maybe calling it something else. Has anyone else had to face this issue? What have you done to get your child help if you can not afford paying out of pocket? He does get OT services at school but not as much as I think he needs.

Comments for
Insurance won't pay

Average Rating

Click here to add your own comments

Dec 04, 2010
Rating

We Won Our Six Month Battle
by: Jewel

Hello - I don't know how your battle is going, but I just won a six month battle with our insurer to cover our son's Sensory Integration OT. If you still need help, I can suggest to you a few of the things that I tried. It was a long, hard, emotionally draining process...but four denials and siz months later, my husband and I are only obligated for his weekly $25 co-pay.

Sep 15, 2010
Rating

Insurance games
by: Christina

Most medical professionals know ways around these things - it's all about how they code it when they send it to the insurance company. Just like the person before me said, talk with them, explain the situation, and they should be able to figure something out. Good luck!

Sep 02, 2010
Rating

Re: Insurance won't pay
by: Anonymous

You should ask the professionals who diagnosed him with SPD how it can be presented in way that the insurance company cannot deny. The insurance companies will reject anything labeled "SPD". Perhaps if you break down the diagnosis into something more specific, then they will have to pay. Although my child's issues were clearly sensory related, we used the term "fine motor delay" to get coverage. At least that got us through the door!

Also, your son should be eligible for physical therapy if he is diagnosed low tone.

Click here to add your own comments

Join in and write your own page! It's easy to do. How?
Simply click here to return to The SPD Q & A

Insurance won't pay

Comments for Insurance won't pay

Comments for
Insurance won't pay