First Steps said NO!

So today I found out that J isn’t going to qualify for First Steps. His speech delay is only 6 months behind development and the Aspergers thing isn’t enough to qualify him. So, First Steps told me to see a pediatric neurologist. I don’t know what to do with that info… because JT called our insurance company and they told us that they will cover speech and occupational therapy as long as it’s not a developmental delay. Um, okay. So basically they aren’t going to cover him because it’s a “pre-existing condition”. Does anyone else think that this is messed up? So now what. I guess I get in contact with my pediatrician and ask her what I should do. I found a place in South County that looks perfect but they charge $80 for one session of occupational therapy and $60 for one session of language therapy. I know that J is worth the money, that’s not my issue. My issue is being able to afford more than one or two sessions. I feel like I am staring at a wall of no answers.

Why do they let their OT’s walk around dropping labels like Aspergers Syndrome, as in your son is showing signs of potential Aspergers and then not help you?! I kind of knew that he wouldn’t qualify with the speech thing because he is understanding at almost a 4 year old level but he isn’t able to say what he wants. Even if I take him to a pediatric neurologist the insurance company won’t cover anything. Unless we spend $500, which is our deductible. It’s $45 to even just see a specialist (co-pay) so we only have $455 left. If you have any advice it’s appreciated.

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3 thoughts on “First Steps said NO!

  1. Ian says:

    Sorry you have to deal with the insurance aspects of therapy. They can be incredibly difficult to navigate.

    One option is to go to the one or two OT/ST sessions with J, and tell the therapists your goal is to learn the exercises from them that will help J longterm. Read up online regarding the types of therapy available, so that you can absorb the specifics they show you quickly. Then do the two or three sessions you can afford to get them down. Maybe the first session you watch them, and the second session (a couple weeks later during which you’re practicing at home), they watch you (and fine-tune your technique).

    Then you can go back periodically as J gets older (every 2-3 months?), and outgrows the exercises you know how to do.

    The therapists should be more than willing to do this sort of thing, and if you are diligent, J will benefit tremendously (plus get a bunch of quality time with mom!)

    Good luck.

  2. hotomom says:

    Wow thank you so much Ian. That was wonderful and extremely helpful information. Thank you for all your help. I will start a plan into action on Monday.

  3. I am afraid I have no advice to offer but I definitely agree with you that this is a messed up situation; how ‘pre existing’ can a condition be in a 2 year old?

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