ktgrok Posted March 7, 2011 Share Posted March 7, 2011 So, although coverage for austism/aspergers is mandatory in my state, my plan is self funded so it doesn't have to follow the law. So they don't cover it. And...even if they did, the big group that does social skills classes and such is out of network. I have a $750 deductible for out of network, then it only pays 70%. Which I know is better than most people, but still. I don't have $750 dollars. The initial consultation is $160, then the classes are $120 for a package of 4. ugh. That's $120 a month. I don't have an extra $120 a month laying around, for something that might or might not help. But this place looks great....the guy that deals with Asperger's works only with kids. He set up a skateboard team (my son LOVES skateboards), there are horse therapy day camps, etc. We are just going to have to find the money somewhere I guess, but I don't know how. Quote Link to comment Share on other sites More sharing options...
Mission-Driven-Mom Posted March 9, 2011 Share Posted March 9, 2011 I agree with you!! I have 4 kids...3 of which have some needs and have been recommended therapy...our insurance has a very, very large deductible so alot is assumed OOP. I suppose you have to weigh the benefits...most recommendations are legit but you do have to be somewhat of a skeptic. When you decide what the most important interventions are and will be and you commit then you can re-evaluate the spending and budget to see where and how you can cut corners. I do things like...stop and shop at thrift, consignment sales, garage sales for clothes and accessories (and trust me...you'd never know...I find great stuff!), clip and use coupons (although they aren't as useful these days that we are GFCF), carpool or cluster our trips out to save on gas, we don't eat out, we don't go to the movies or anything of the such, etc. At one point we cut our cable down to basic (which saved us $50/mo.). You can also have a garage sale, sell things on ebay, find a direct sales company to work with ...I have done this for yrs now...great on the tax refund (lots to write off, like cell phone...etc!) and provides a flexible source of extra funds (I am sure you can find something that fits you)..., I am sure there are more ideas but I know these are all things that have helped us! I know there is no easy answer. It takes sacrifice and action on our part but I do hope I gave you some ideas to get your started. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 9, 2011 Author Share Posted March 9, 2011 Thanks. I've calmed down a bit about it. The one place sounds pretty awesome, and if I buy a package of social skills classes I get a discount, so they are 30 a class. That's actually less than my copay, so I can't really complain. It's just frustrating to have to weigh financial concerns against my son's health and happiness. Quote Link to comment Share on other sites More sharing options...
Mission-Driven-Mom Posted March 9, 2011 Share Posted March 9, 2011 Thanks. I've calmed down a bit about it. The one place sounds pretty awesome, and if I buy a package of social skills classes I get a discount, so they are 30 a class. That's actually less than my copay, so I can't really complain. It's just frustrating to have to weigh financial concerns against my son's health and happiness. Good! I know, it's emotional to digest it all! It does sound like a great program. And I understand, the latter statement too. My friend says that is our momma bear coming out in us...hence, making us good momma's for caring and advocating so much for our kid(s). Quote Link to comment Share on other sites More sharing options...
AmyinMD Posted March 9, 2011 Share Posted March 9, 2011 We're also in a state with mandated coverage and it's still going to be a lot. I'm going to use as many school services as I can for my 3 yo ds but it is not enough. Our insurance covers Speech and OT for spectrum disorders but the copays on each are $40 and I'm having trouble finding an in network provider close by. Out of network we pay the first $1000 plus 40%. It's certainly better than not covering it but I'm thinking I'll only be able to swing one therapy session a week and I think he could use more. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 9, 2011 Author Share Posted March 9, 2011 I'm waiting to hear what the school says, they of course are acting like he gets nothing because he is a homeschool student. Ugh. Quote Link to comment Share on other sites More sharing options...
SweetMissMagnolia Posted March 9, 2011 Share Posted March 9, 2011 we're lucky our insurance covers it at 100% (so far I haven't gotten a bill)--we see our pediatric behavior specialist/psychologist once a month most of the time (depending on if we can get an appt) and the sessions are between 30mins and 1hour.....a few years earlier when we had just started to have him evaluated our insurance changed and it wasn't covered--but with hubby's new work contract the new insurance covered it--when we first started seeing her before we got a diagnosis it was a $10 copay per visit out of pocket.... Quote Link to comment Share on other sites More sharing options...
gingersmom Posted March 9, 2011 Share Posted March 9, 2011 In lieu of gifts I told my family they could pay for therapy. I wore shoes with holes in them. My kids did no extracurricular activities/summer camps. We rarely ate out, went to movies, anywhere (unless someone else was treating). I shopped for clothing essentials only and on sale. It was very very difficult on the one hand and very rewarding on the other (seeing the amazing changes in my son). If I had to do it all over again I would. Quote Link to comment Share on other sites More sharing options...
Mama Pickles Posted March 11, 2011 Share Posted March 11, 2011 In lieu of gifts I told my family they could pay for therapy. I wore shoes with holes in them. My kids did no extracurricular activities/summer camps. We rarely ate out, went to movies, anywhere (unless someone else was treating). I shopped for clothing essentials only and on sale. It was very very difficult on the one hand and very rewarding on the other (seeing the amazing changes in my son). If I had to do it all over again I would. :iagree:Luckily it only took us just under a year to jump through all the hoops to get insurance to cover OT through the autism law in our state. We still have to get "recertified" every 3 or 4 months and we still have a copay, but it's better than when we had to pay $170 a session out of pocket. DS1 now has OT twice a week, but I would go back to extremely thrifty shopping, cutting cable or whatever I had to do to make it work. OT has helped my son come so far. Quote Link to comment Share on other sites More sharing options...
Dobela Posted March 11, 2011 Share Posted March 11, 2011 I finally applied for state funded insurance for my kids (Medicaid) that is disability based because we just couldn't sacrifice more than we were and pay for therapies. It took 18 months for my son to qualify and then they made the coverage retroactive to the time of application. We pay a small monthly fee based on income, and they pay for therapies. Or almost all of therapies anyway. Right now they don't have any other insurance because we can no longer afford to pay for private insurance and or employer doesn't provide it. When we had private insurance, the Medicaid paid whatever the private didn't. Quote Link to comment Share on other sites More sharing options...
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