(Upper Darby, PA)
Are there any programs or assistance for kids with SPD? I am a single mom of two kids and my daughter has SPD. There are no OT providers within an hour of my house, at least that I can afford. Should she then by denied proper medical care? What's insurance for anyway?
The SPD Help Line Answers
Ah, the insurance issue… that can be a tough one. But, there are ways around it. First, I am wondering… do you have a SIPT certified OT you can go to? If you want to check for one in your area (where do you live?), go to: www.wpspublish.com
; click on your state and it will bring up a list of OT’s that are trained in sensory integrative theories and treatment. They may be better at working through the insurance companies.
As far as insurance specifically, there are diagnostic codes that can be used and creative wording that can be done by your OT. For a list of commonly covered diagnostic codes, click here
The problem with insurance reimbursement is that SPD is only recognized in one diagnostic manual at this point, so many insurances don’t “accept” that diagnosis. If other diagnoses or functional issues (which I am sure there are functional issues) are present, therapy can be provided through insurance if the right wording is used… an experienced OT should be able to accomplish this.
Until we get SPD into the DSM V, this will continue to be a problem, unfortunately. But, know that Dr. Lucy Miller and her team are diligently working on this. We hope it comes through. Right now, the only diagnostic manual it is in is the ICDL (click here for more on this)
. That’s a start. But, talk to the OT’s about some creative wording and how they can get the insurance to pay for it… just don’t use the words “SPD or Sensory Processing Disorder” as it won’t be covered that way (usually).
One more article that may help you is; Financial Help For Sensory Products And Therapies
Hope this helps. Good luck.
Anyone else have any ideas? How did you get your therapy covered by insurance? Any OT’s reading this know any tricks? If you can let this mom know… she would greatly appreciate it, I’m sure!
Take good care.