A Step By Step Guide
For SPD Parents:
The Seven Steps For Helping
Your SPD Child

Step Three

Find out which clinic, hospital, program, or private therapist will be the best place to have an Occupational Therapist evaluate your child (or YOU, if you are an adult seeking a diagnosis and treatment). Note that ages 0-3 will want to find the "Early Intervention" program, and ages 3-5 will want the "Child Find" program in your area... both of which should be run by your town's school department.

Please read the following two articles carefully for help:

ALSO, make sure you call your insurance company AND ask the facility or the OT whether they accept your insurance for such an evaluation. Just a warning...often they will not, YET! These evaluations CAN BE quite costly (up to $800)...but, how can you really put a price on finding the proper diagnosis and treatment for your child? Believe me, it is MUCH more "costly" in both time, frustration, money to be given incorrect and unnecessary tests, diagnoses, and even medication! Once you receive the PROPER diagnosis, treatment will seem relatively "easy".

I can't tell you how many parents would have GLADLY shelled out the money necessary for a proper evaluation, had they only known!!! Years and years of doubts, blame, frustration, misdiagnoses, endless and unnecessary doctor's visits and treatment, as well as increasing symptoms/difficulties at home and school have all, LITERALLY, almost destroyed lives! Please don't let it get this bad for YOU!

One more thing on insurance... In MOST cases any form of Medicaid WILL cover evaluation and treatment as long as the therapist uses the "right" codes for reimbursement and the proper wording to justify it. This is precisely the reason my friend Michelle Morris has put together a nice list of "Commonly Reimbursed Diagnostic Codes" (see link below) which will apply to regular insurance as well as Medicaid. So, in most cases, using acceptable diagnostic codes, Medicaid covers almost all necessary OT services for SPD.

Michelle adds, "Additionally, for instance, it will cover therapeutic interventions, right? But not cover equipment like Listening Therapy equipment, brushes, massager, companion programs (for example, Handwriting Without Tears) etc. UNLESS a person has CMS type Medicaid. If they DO, then a parent may apply to get a certain monetary allowance to cover specific therapeutic equipment, and these items can be purchased with the money. So... there are rules and then there are RULES, and depending on how savvy the OT is, and the wording USED this can be different.

But yes, the general rule of thumb, using the appropriate diagnostic codes when requesting payment by Medicaid for SPD OT, they cover it... the evaluation AND treatment."

(More tips on insurance reimbursement and financial help listed under STEP SIX)

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