Insurance approved speech therapy sessions ran out

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amother

Mon, Aug 01 2022, 12:11 pm

Hi,

My 3 year old son is getting speech therapy for a few different issues and it is a long process. Baruch Hashem he is definitely making progress but there still is quite a bit of a way to go.
We ran out of the number of sessions our Aetna insurance approves. Now we would have to pay privately for all the rest of the year.
Does anyone have experience with Aetna approving more sessions, or any other ideas what to do?

Thanks.

amother

Bellflower

Mon, Aug 01 2022, 12:12 pm

Every plan is different. Does your plan limit you to a certain number per year? If so, that's all you can count on. If they authorize according to what the therapist submits, you can ask for an appeal.

amother

Mon, Aug 01 2022, 12:20 pm

Ok thanks. I think this is the amount the plan limits so I guess that's that.

Does anyone here pay out of pocket for speech therapy and know how much it is per session? The amount they told me it would be is higher than what we paid less than two years ago for a different child, at a different clinic.

I know prices of most things have gone up. I know I have different insurance now. I know this is a different clinic, different child, different issues. I just want to see if the price is in line with other places currently.

Thanks.

erm

Mon, Aug 01 2022, 1:28 pm

Why don't you have him evaluated by the DOE? Then therapy is free

amother

Sand

Mon, Aug 01 2022, 1:30 pm

I have lousy insurance so when I was looking into therapists I called several places and asked what their out of pocket rate was. They were happy to tell me. Maybe call around and compare pricing. Especially if you’re willing to switch therapists.

amother

Bellflower

Mon, Aug 01 2022, 1:30 pm

erm wrote:

Why don't you have him evaluated by the DOE? Then therapy is free

This depends where you live.

Same for you, op.. depends where you live. I think it's around 75 for half hour where I am but that may not be relevant to you.

amother

DarkOrange

Mon, Aug 01 2022, 2:04 pm

This happened to me!

Please please reach out to your pediatrician and have them call the speech therapist/insurance. I can't remember what this procedure is called peer to peer maybe? but the doctor and therapist can kind of override the limit by stating that the need is still there. All I know is my doctor called, and the insurance ended up covering another few months. Its not like you'll get unlimited, but every session counts. Good luck! There is a time limit on this, I can't remember details, but something like a couple of weeks for the window in which you can challenge the discharge.

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