Wednesday, July 14, 2010


Sorry, I need to vent.

I HATE insurance companies. As mentioned in my previous post, Lexi needs to have a feeding evaluation done. I called Easter Seals, who her pedi told me to call, and spoke to the occupational therapist. Basically, both the OT and a speech pathologist are involved in the eval...the OT will look at how she sits, breathes while sitting, what she does with the food (hand wise) etc. The speech pathologist will actually look to see what Lexi does with the food once it's in her mouth. The kicker? My insurance company won't pay for the speech pathologist portion of the eval...because Lexi isn't on the Autism spectrum or have a congenial defect.

WTF?? The problem lies with once the food is IN her mouth...and because my child is considered developmentally "normal" (whatever that is) they won't cover any therapy! In essence the insurance company is telling me that it's a behavioral thing that she'll "grow out of". Um, MY CHILD LOST ALMOST A POUND IN LESS THAN A MONTH, and you're going to deny her coverage??!! I'm BEYOND upset.

The only saving grace is a state funded early intervention program (Child and Family Connections or CFC), but get this, Lexi doesn't qualify on a feeding eval alone. CFC said Easter Seals does free feeding evals. I told CFC that ES told me they don't. So my saving grace? The fact that Lexi doesn't have 2 -4 words yet. She's qualifying under a speech referral, which will include the feeding eval.

So while I'm ultimately getting the services that she needs...I can't believe that I just spent my entire morning arguing with ES, my insurance company and CFC over this. I have a new found appreciation for those who fight this fight every single day on behalf of their kids.


Anonymous said...

Insurance and health care in general bite the big one. They are forever pointing fingers at who owes what.

Good for you for getting Lexi what she needs. I hope they can help her!

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s.e. said...

I am a speech therapist and I didn't fully appreciate the system until my kiddos needed to be evaluated by CFC and started receiving physical therapy.

It is all too confusing and frustrating. I am glad you got a solution in the end!