We've had a private policy through Blue Cross Blue Shield since 2005 (when I "retired" from the Shack). Up until the first time I started looking for SLPs to help Charlie, I thought BCBS was a pretty good company. That opinion changed drastically once I realized how little they do to help their customers.
In all the years we've had BCBS, we've really only used the office co-pay benefits (with 3 kids, I'm at the doc all the time...like just last week!!!). Thankfully, we have rarely used the other benefits. But the time our child NEEDS something, we get nada. Here's why according BCBS.
For children under 3, BCBS only provides benefits if the child has a developmental delay as documented by a treatment service plan through Early Childhood Intervention (ECI), which is a state-run program. Apraxia is NOT a delay...it's a neurological disorder. And ECI dismissed Charlie from their care in September 2011 because they didn't have an SLP who could help him (their words, not mine). Since we didn't have a service plan through ECI, BCBS denied all our claims for private therapy. And they denied my appeals too because he didn't have a developmental delay. I must have talked to them every week for six months. I even got a case manager, but the answer was always no.
For children under 3, BCBS only provides benefits if the child has a developmental delay as documented by a treatment service plan through Early Childhood Intervention (ECI), which is a state-run program. Apraxia is NOT a delay...it's a neurological disorder. And ECI dismissed Charlie from their care in September 2011 because they didn't have an SLP who could help him (their words, not mine). Since we didn't have a service plan through ECI, BCBS denied all our claims for private therapy. And they denied my appeals too because he didn't have a developmental delay. I must have talked to them every week for six months. I even got a case manager, but the answer was always no.
So then Charlie turned 3 in July. And guess what? STILL NO BENEFITS!!! As a 3-year-old, we would have to prove he has an acquired brain injury to get any benefits. Apraxia is not acquired, nor is it caused -- at least in Charlie's case -- by a blow to the head. BCBS specifically excludes any other speech and hearing services after age 3 unless the services are treating a brain injury.
It's so frustrating to know that we've paid a ton of money in premiums over the last several years to BCBS. Yet when our child needs something that necessary, no, critical, to his development, BCBS says we don't have coverage for that. Do they think apraxia is something we wanted Charlie to have? Do they think I enjoy chasing insurance forms and case managers and sitting on the phone for a hour at at time? The answer is a resounding no. I'd much rather spend my time working with Charlie on his sounds, thank you very much.
If you aren't aggravated enough already, when I checked another policy's benefits, it specifically excluded apraxia by name. And most moms of apraxic kiddos have similar stories. We get no help from insurance.
Everything I read on apraxia treatment says children with severe apraxia like Charlie need 3-5 individual therapy sessions per week. And that's just speech. Other recommended therapies include occupational therapy, music therapy, hippo therapy and vision therapy just to name a few. While we are certainly willing to do anything to help Charlie, we do like to eat and have gas for our cars:) I wish we could do it all for him, but right now we have to pick our battles.
So the long answer is insurance has not paid one dime for Charlie's therapy, and unless something changes, it won't ever pay. Every dime we've spent for private therapy has come out of our pockets. And SLPs don't have a discount if you pay cash:(
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