Wednesday, July 20, 2011

Apraxia - Insurance and Diagnosis

My feeling at the moment is that I need to do something to help Luke NOW.

Many people have said to me, so and so didn't talk until they were {insert age here}. Einstein was a late talker. His big brother is talking for him. He'll talk when he's ready. I know that they're trying to make me feel better, but I'm at the point where I don't want to hear it. I'm his mom, I want to fix it. I would go bankrupt and sell every single possession of ours if all the money we could possibly pay would make things right for him. Because my mama's instinct tells me that something isn't right, that we will need to do something to help him.

Insert my desire to find private speech therapy for him. Kids with apraxia don't respond to traditional speech therapy. That's because apraxia isn't a developmental delay. From Medterms;

A severe speech disorder characterized by inability to speak, or a severe struggle to speak clearly. Apraxia of speech occurs when the oral- motor muscles do not or cannot obey commands from the brain, or when the brain cannot reliably send those commands. Children with apraxia can be helped significantly with intensive speech therapy.

And this of course means that the typical Early Intervention speech therapy will not help him to the extent that he needs.

It also means that the people that insist on saying to him "t-t-t-truck" can s-s-s-stop. Seriously, please stop. I'm not sure you'd want to teach any kid with a speech delay to say "t-t-t-truck" instead of truck anyway, I just don't get it.

A few weeks ago we met with a wonderful PROMPT therapist/instructor who evaluated Luke. She felt that he would benefit from that type of therapy, and wanted us to come once a week.

Enter insurance issues. We are going to have a new plan the first of August, and reading through the policy requires a lot of patience. Essentially it says that a child without a diagnosis, of a disorder such as apraxia, is not eligible for speech therapy benefits. In order for insurance to cover Luke's speech therapy, we need a diagnosis beyond developmental delay. We've already been to one developmental pediatrician, who after 10 minutes (most of which was spent talking to me) said "possible apraxia". I'm not an insurance expert, but I'm going to bet that "possible" won't float the insurance company's boat enough to help us out.

So I contacted the PROMPT therapist, and she recommended a developmental pediatrician in our general area. First available appointment? Early December (awesome). Appointment length? Two hours (awesome again, but this time not a sarcastic awesome). Cost? $570 (thud! - the sound of me hitting the floor). Even better? He doesn't take insurance (sarcastic awesome again). I made the appointment anyway, and we'll just see what happens. My mantra is, whatever it takes.

Until then, the PROMPT therapist has agreed to see Luke once a week for 45 minutes starting in September, knowing that it may or may not continue, depending on how much we can afford and what insurance decides to do with us. If we get the diagnosis, our insurance coverage for speech therapy will be amazing. Much love to the wonderful people at UPS for providing awesome health insurance benefits. Going from our over $500 a month with a $5000 deductible plan that didn't cover much to the plan we'll have with UPS is like willing the lotto.

It's going to be a journey, but it's worth it.

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