And She Lived…











{November 6, 2008}   Almost Beyond Hope

I am beyond frustrated with the people who are supposed to be helping my son. Insurance has denied coverage for Meechi’s physical and occupational therapy. I just don’t understand this. Meechi is 35 months old and his evalutaions found him to be at a 26 month level. He is nearly a year behind and insurance DENIES him help. How the hell do they justify this??? He has been diagnosed with SPD. He needs an occupational therapist to assist in giving him the therapy he needs to overcome this. He NEEDS help and support to learn how to simply live with what the rest of us accept as normal. And insurance DENIES him that help!

I’ll be totally honest here and admit that right now my kids are on medicaid. When I lost my job we lost our insurance. My husband has not been at his job long enough to qualify for insurance yet. So in the meantime we have had to seek some help so the kids will be covered. We go without insurance for ourselves.

If THIS is what government regulated health care is… if it is denying a child the services he desperately needs…….   well, we’re all pretty much screwed aren’t we? If the future of our country is having someone in power who wants to put the government in charge of healthcare…….  will any special needs child be allowed the services they need?

I’m worried, and I’m pissed off. I’m sad and I’m frustrated. I am confused and I’m almost beyond hope.

All I want is something simple. Help for my son. Why? Why will they not help my son?

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Anna Heald says:

I am so sorry about being denied the services that will help your son. Our pediatrician said that the medical insurance won’t cover therapy either if we seek help outside of our county’s programs. I agree it is frustrating. We have a speech therapist, who does address our little ones sensory needs, but I do wonder if working with an OT would benefit her too. Hang in there, don’t lose hope.
~Anna



Have you tried to register him with the local Department of Developmental Delays? In our state the Medicaid medical is based on finances only, the DD services on diagnosis, at least then you would have a specialist directing Medicaid to cover the services!



me says:

He doesn’t qualify for early childhood intervention? Why blame Obama?



bqkimmy says:

just to clarify:

he qualifies for early intervention. we’ve tried that and it lacks in the areas he needs the most help. it is not a matter of not QUALIFYING. the problem is he DOES qualify. and this is not about early intervention, although our local ei program really is quit lacking. It is about government run healthcare. as in medicaid. which if obama really follows through on this healthcare thing, which i don’t think he will anyway, then we are all going to be faced with the kind of decisions i am having to deal with right now. GOVERNMENT RUN HEALTHCARE (not early intervention) DENIED MY SON SERVICES THAT HE DID QUALIFY FOR. they denied him simply because THEY felt it was not necessary. nevermind the fact that the experts on these areas of development and special needs say that it IS NECESSARY.



I can’t believe you can’t get medicaid for him. Maybe you can and I’ve misread somewhere. Have you signed up for WIC? He’s under the age of 5 and would qualify and WIC would be able to help out with some information and possible other avenues to pursue. Just a thought.



Patty says:

I know what you mean about EI services. That is where we first got help for my son, who at 2 years was not talking at all. He was finally diagnosed with SPD (we took him to a private therapist and paid ourselves for the diagnosis) but the EI system didn’t really offer any real help for SPD. They sent over a PT instead of an OT and she really didn’t know much at all about SPD. Luckily, our insurance has covered therapy, butget we have to travel 3 hours to CHicago to find a therapist who knows what she is doing.

I don’t know if this will help you, but we only go to therapy once a month or once every other month. She sets up a home program for us to do ourselves. The only problem with this is you do have to buy some therapy equipment which even decent ins. co’s definitely won’t pay for.

It really makes me sick, because I have heard of many people who have insurance through work and their companies won’t pay either. I wonder if this will change once they finally get SPD listed in the DSMVI…. Maybe then they will actually recognize it as a real disorder. Jerks.



Sheila says:

That is beyond frustrating! Have you found any OT that perhaps you can do at home with him? I found a link to a book called “Pathways to Play! Combining Sensory Integration and Integrated Play Groups”, I know it’s not the same and it certainly does not make up for what he is missing out with actual OT, but maybe it is something that can be utilized for now.



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