NP, VT, OT- How do you pay for it all?

[nancyb]

I don't really know where to start, so I’ll start at the beginning. My extremely laid back son is currently 10 years old. He didn't speak or make much noise until he was 3 or so. My family called him “surfer boy†because he was so laid back. We thought maybe that’s why he didn’t’ talk, but the state paid for an evaluation and sent a speech therapist to the house once per week. She got him to talk more.

 

Then we noticed his speech was over articulated. After more speech therapy and numerous evaluations, the experts decided it was due to his severe under bite. So we spent thousands at the orthodontist. He now speaks pretty normally.

 

His older sister was in a rigorous classical school. While he would have done fine in public K, I knew the classical school would be difficult, so we delayed K a year. He loved school, but by first grade, his schoolwork wasn’t getting done at school. So he was coming home with all of his homework plus schoolwork making our evenings miserable. I wondered if he had add.

 

I decided to pull him out for second grade and see if I could help him. EVERYTHING was a struggle. It was awful. I didn’t know if it was his laid back personality, if he was not trying or lazy, or if something was wrong. Halfway through 2nd grade he mentioned it hurt his eyes to read. It turns out he had convergence issues.

 

During the months of waiting to get tested and see a vision therapist, I had him evaluated at Learning RX. They were offering free testing at the time. His processing speed was in the 2nd percentile. I knew he was slow but not that slow. After looking at Learning RX and VT, I saw the programs were similar but my insurance was going to pay for VT. We spent most of his 3rd grade year in VT.

 

His convergence issues are mostly gone, but testing shows he still has other visual processing issues. The dr recommends another round of vt. This time my insurance is not covering it.

 

I had hoped his handwriting and spelling would improve when his convergence issue was fixed. At 10 years old he still hates to write, struggles with reversals and his writing is extremely slow. His spelling is terrible too. Interestingly, his ITBS scores shows his reading comprehension is above grade level. This summer I learned about Diane Craft and was loaned her dysgraphia video. We have been working on our writing 8’s for a few months and I see a little difference.

 

Anyway, this year homeschooling has actually been fun. I’m not sure if the improvement is from therapy, maturity, curriculum choices or all of the above. I am using the following curriculum: Rightstart, Sequential Spelling, IEW, Winston Grammar with EEL (Classical Conversations Grammar) and memory work from Classical Conversations. All of the programs are teacher intensive, but they hold his attention and require little writing. He dictates his IEW to me. We could probably go on like this for a couple of years. But when I think about it, he could really use a lot of intervention. And it’s my understanding that if he is going to get these accommodations later (like a scribe or extra time), he needs a real diagnoses now. So he needs a np evaluation, vt and probably ot. Each of those are thousands of dollars!

 

So, I guess I’m asking if there is something I’m missing in my observations/evaluations? Do you see something else in this very long description of my son. Also, what should I do? How should I pay for all of this? What about public school? Do they give decent evaluations/therapy and is it free for homeschoolers? Should I just stick my head in the sand and be grateful that we are having a good year? I hope all of this makes sense because I’m having a hard time articulating my confusion. :tongue_smilie:

[PeterPan]

The problem with putting your head in the sand is you end up snorting and choking on it.

 

Definitely it's time to look into a np eval. That way you can start getting a complete picture and see if there are other things you're not catching. Not EVERYTHING requires a $100 an hour professional to work on, even though it feels like it.

 

As far as the OT, I'm mixed. Ours was hairbrained. In retrospect, I wish we had done once a month with more homework and with someone who was more organized. If you feel like this year is pretty functional except for a couple things, that would be my advice. There's no need to buy into their "look, a new cash cow!" system if what you need is some help coming alongside your efforts.

 

On the VT, you know I'm all in favor of it, but it shouldn't be this interminable process. I'd make sure you're confident in your doc and the results he was getting. Maybe you should look to see if there are other options. The therapist makes all the difference in VT, and again it's something where you can do less frequent visits and more homework.

 

If you do OT once a month and VT every other week, maybe it looks more in range? Don't know. Just saying that's probably a lot closer than VT every week AND OT every week, which is what they all seem to want, ugh. As far as the np, that usually takes a couple months to get into and they don't get paid upfront necessarily. So if you start saving now and don't end up with results and paying for 6 months, that gives you a while to save up for it.

[MomatHWTK]

What does your insurance cover- if anything?

[Crimson Wife]

Does he have low tone and/or any other motor delays aside from the handwriting? Our family's pediatric neurologist was able to get every other week OT approved for youngest DD by our insurance with a diagnosis of hypotonia and dyspraxia. She is seeing a fantastic OT who has all kinds of suggestions for at-home activities I can do to supplement the formal sessions.

 

In terms of the NP eval, that I haven't done because the child who needs it to determine whether she has CAPD, ADHD, and/or working memory issues can compensate enough to get by for now. I only have so much time, energy, and patience to devote towards dealing with our insurance company red tape, finding good therapists/doctors/etc., and schlepping to & from appointments. Youngest DD's autism takes precedence at the moment over whatever is going on with her older sister. Also, the NP report will only be valid for a certain length of time, so if the insurance will only pay for 1 eval, I want it to be done in high school.

[Dobela]

We were able to get a form of state insurance (it is under medicaid but not called medicaid) that covered therapies our insurance did not cover. To qualify our son had to have a diagnosis showing disability from someone. For him it was OT showing he was 2 SD below and needing therapy. We pay a small premium each month based on income. They bill our private insurance first, then cover what private insurance doesn't cover.

[Tiramisu]

Have you ever had a full evaluation from a neuropsych or educational psychologist since he was taken out of school? It's been a couple of years, I guess. I would start saving up for the neuropsych evaluation or go to your school district and request an evaluation. Even if he's getting by very well with homeschooling, he may need some kind of accommodations in the future and it's really important to start a paper trail of documentation.

 

I'm totally sympathetic in terms of the costs of evaluation. I've almost always limited myself to what we can get covered by insurance. Things are hard, but I know I need to get the NP eval done before college, one way or another.

[Ghee]

I'm :bigear:. We are in a similar boat. My 8 year old needs VT, OT, Speech, and (according to the NP) reading intervention. Well, his deductible is $2500 and we've paid a whopping $30 towards it. So that leaves us with $2470 left to pay before they kick in on the OT and Speech. Insurance told ME they would pay 100% of VT, if he had a medical reason for needing it. He has amblyopia, astigmatism, near and far sightedness...plus other issues. The insurance told me that should mean they pay for the VT, the VT dr's billing girl says they WON'T pay for the VT and wants me to buy $700 worth of time up front (10 sessions..) Okay, except I'm going to be out close to three thousand on the OT/Speech...if insurance will pay for the VT, then, heck yeah, I want them to do that! Still trying to figure out how to get insurance and VT office on the same page.

 

On top of that, the NP recommended this reading place. It's like a home grown Sylvan. I'm a little underwhelmed, after talking to them. They want $20 application fee, $50 eval fee, and then $25 an hour for however many hours they deem he needs. I asked if he were dsylexic, how would they handle that. She said "Is he dsylexic?" I said, "I don't know. Don't you test to find out WHY they aren't reading before you start trying interventions?" The answer was no, they just start trying things and "see what sticks". For $25 an hour? No, sorry. Not when I know I'm out $2500 for sure, possibly $3200....I'm not giving you $25 an hour to do what the school system was doing for free. I want to know WHY he can't read yet. Then I think we will know exactly what steps should work to remediate that.

 

I understand, it's an uphill battle to afford all the services. The NP has been our LEAST expensive venture. He only charged $550 for three sessions. For whatever reason, the deductible did NOT apply to him and insurance paid all but the $20 copay on that. They just won't pay for all the stuff he has "prescribed". Go figure.

[prairiewindmomma]

We chip away at things a little at a time....we have had three kids so far with varying needs...we triage between what's most urgent/important.

 

We paid for vision therapy entirely out of pocket for one child. We got a visit to the developmental pediatrician covered by insurance, but the neuro-psych eval is not covered....and it runs $2400 here (at the least expensive but still good place). We are slowly trying to save for that. We half-enrolled one child into public school so that he could get some sort of OT/PT/and ST.....all of these had very limited to no coverage by our insurance.

 

We have done crazy out-of-the-box things over the years....paying for two OT/PT training sessions and doing most of the therapies at home ourselves with visits every couple of months to get new exercises and fine tune technique. I videotaped the sessions and was given written instructions. We did something similar with VT. When my ^dd^ was fighting her brain tumor, we enrolled her in a drug study through NIH that also allowed her to be seen by all of the specialists there...ped neuro-opthamologist, ped PT, ped SL-P, ped OT, rehab medicine dr., etc. at no charge to us. They even outfitted her with a resting hand splint.

 

We have seriously considered sending me back to work to be able to pay for more therapies, but at this point, we believe that the benefits that come from me homeschooling our kids are greater than what they would receive if we enrolled them in public school and did therapies on the side.

[fiddle]

We chip away at things a little at a time....we have had three kids so far with varying needs...we triage between what's most urgent/important.

 

 

:iagree:

 

Our insurance covers NOTHING. I'm not kidding when I say that. It won't cover VT. It won't cover auditory evals. It won't cover Nueropsych evals. The only thing we've had covered is the "regular" hearing tests, which are ongoing, because dd has a documented "medical" hearing loss. I've got an older one that I suspect has APD, but again that eval would run about $695 where we are. We just paid about that for our dd's vision eval, and waiting to see at $99 per session how much VT will run us. I bought a $15 auditory workbook to do with my oldest and we'll just have to take one thing at a time. Right now, I want to focus on getting youngest dd's vision/tracking issues addressed........

 

It does get overwhelming. And it is tempting to put dd back in ps, but after I remember what it was like dealing with the specialists "team" I'd rather work my butt off giving as much in-home therapy as possible and paying out of pocket for anything they need that is critical;)

 

Paula

[Mom-ninja.]

My insurance also covers nothing. How do you pay for it? I have no idea. I haven't figured it out. We just so happen to fall in that income range of make-too-much-to-qualify-for-programs and make-enough-to-actually-be-able-to-afford-therapy. Dh makes too much but not enough. :glare:

[crazyfordlr]

The only thing our insurance covers is Interactive Metronome b/c they consider it OT. Everything else is OOP.

 

We go without, my ydd goes without. I feel bad about that. We try to make it up to her in other ways that don't require money. She's now in karate - I afford it by giving up my haircuts and clothing allowance/budget. (I work for a company that has t-shirts/jeans/sneakers as their dress code so that helps.)

 

We are really upfront with our therapists and we make a plan about what should come first, second, third, etc. I take on some of the therapy at home ... that way we can spread out our appts. I borrow books/games from our therapists to "play" at home. Thank goodness ydd likes most of the games too :)

 

Also, I have picked up a few tutoring gigs. This extra cash allows us not to charge things ... something we're adamant about not doing. That being said, we have charged a few things.

Edited September 20, 2012 by crazyfordlr

[herekittykitty]

HSLDA has some special needs financial assistance. I think you have to be an HSLDA member for 6 months and then you can apply. I don't know everything that's involved, but they talked about it a bit at the home school conference I went to this past summer. I believe the info. is on their web site.

[Maverick_Mom]

We went through the school district because it was free. I know some districts are wonderful and can be a great source of help and support ... but that was not the case for us. Their main focus was to get ds enrolled in their program as a full-time student, not just receiving special services. And although our district was supposedly well-known for the training of its special-ed staff in autism spectrum disorders, I was very disturbed by the lack of patience demonstrated with ds and the ignorance demonstrated by people who were supposed to be the experts. For instance, the occupational therapist informed us that ds' struggles with ball skills were due to his having been homeschooled. Nope, couldn't possibly be that kids on the spectrum often have problems with coordination and low muscle tone. As time went on, there was less and less adherence to his IEP, and everything felt like a fight. It was not a good experience.

[PandaMom]

It took a while to figure out how to pay for everything. DH's insurance pays for nothing as they fall under federal law and not our state law. We paid OOP for OT/ST once a week but DD desperately needed more. Then I lucked out and got DD into a ST program at our local university in the Dept. of Communicative Disorders. They utilize grad. students to do ST 2x week under the supervision of clinic directors. The cost was based on income but trust me was nothing compared to what we were private paying. This is DD's 3rd year and she is doing so much better. Since DD is attending ST at the local univ. they also did a CAPD test and complete language eval. on her for FREE. Again utilizing grad students so they could get the practice. You should check and see if there is something like this in your area. The neuropsych. eval was totally OOP but was necessary in order to get her therapies covered. Some medical expenses are deductible on your taxes so definitely check into this. We did in one year and it helped quite a bit. The neuropsych told us about a BC/BS policy for kids in our state and strongly urged us to get it BEFORE she rendered her diagnoses. It is a high deductible policy that pays at 100% after a yearly deductible. ASD therapies must be covered by law in our state. Children 17 and under cannot be denied coverage and there are no preexisting conditions. We use DH's policy for all her doctor visits, meds etc. and the other policy only for her therapies. The monthly premium is high but is totally worth it. We met the deductible in 2 months this summer and the plan is paying for everything now at 100%. She now receives private PT/OT/ST 6 hours a week covered by the insurance and 2 hours per week at the univ. ST program. We could never have done this for DD if it wasn't for the 2nd policy. Please PM me if you have any questions:001_smile:

 

Susie

DD Dallas (7 y/o)