Help With Occupational Therapy

by Marna Purcell
(Riverview, FL, USA)

I live in Tampa. My son is 7. He was getting OT since he was 4 years old. Insurance now refuse to pay. He has Sensory Processing Disorder. He is now going backwards and not progressing in school anymore.




Who can help me? What resources can I apply for? The school system in Hillsborough County will not give him OT. I don't know where to go.

Thank you.

The SPD Help Line Answers...


Marna,

Does your son have an SPD diagnosis from his Doctor or neurologist? If he does you can request an evaluation through his school district (kind of like early intervention, but that is for 3-5 yr olds). The NCLBA (no child left behind act) will have guidelines that the State must prove your son does NOT need OT. If your son was getting private OT he would automatically be qualified for therapy services through your school district. The school district would also implement an IEP (Individual education program) that you can work with his teachers, therapists, principal even a Doctors opinion is welcome. (The more voices behind your child the better the response.) Did insurance say why they are denying the OT now? Was your son discharged from OT due to progress or insurance issues?

The best resources are your school's counselors, OT, neurologist, a teacher's backing and just you being his voice for him... the squeeky wheel gets oiled. I would call every day until you can speak/meet w/the director of special services in your school district, letters copied to teachers, principals, Doctors, special services for the district and the superintendant of schools. One more thing, ask for your copy of parental rights to DUE PROCESS.

Also, you should check out the Commonly Used Diagnostic Codes For SPD, and check with an OT and your insurance company if any of these diagnoses will help get the services paid for.

If you have any other questions please let me know below and I can try to be more exact with your state's laws and some additional resources.

Heidi~
SPD Parent SHARE Host, Washington



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Jun 12, 2008
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by: Clyde

I'm an Occupational Therapy Student and recently a fellow student sent email that mentions the insurance issue...(in part) "During the last few weeks, my fieldwork site has been noticing that the insurance company Blue Cross/ Blue Shield has in some cases not been covering occupational therapy services so that they can provide cheaper insurance rates to their beneficiaries. We have noticed that physical therapy, speech therapy, and RECREATIONAL therapy services are covered, but not OT!!!!!!!! When my clinical instructor realized this, she stated "Oh no, this is NOT going to be a trend among other insurance companies too, so we need to do something about this."

I have seen this in other places as well. I'm just wondering if there is anything to worry about in terms of people being able to receive OT services if the insurance companies won't pay for OT services.

In the case of the children, the schools are indeed an excellent resource, but what about adults? Are they going to have to forgo OT services because their insurance won't pay? Does this bode well for us students who may or may not have jobs because of this?

I'd appreciate your further opinions on this.
Thanking You.

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