Getting Insurance Company to Cover Speech Therapy

I am not sure how New Jersey works, but in Pa we have the INtermediate Unit. It deals with early childhood intervention and it is funded by the state, just as the school districts are. They will evaluate the child and pay for services. It is a public early childhood education system. I thought my son needed speech, as well. When he was evaluated, I found out that he is not behind enough for speech serveice, but he needs fine motor skills. We then took him to speech therapy privately.

I really don't know about fighting with the insurance company, but another route you might try is through the public school system. Even though your child is not school age, he may qualify for assistance if his speech difficulties are hindering him from preparing adequately for school. I would definitely contact your local board of ed office and see what they can do for you. When I tried this for my son in Medford (he didn't qualify, he was about 50% intelligible) I had to fill in some paperwork, and then there was a screening at one of the elementary schools to evaluate his need.

Best of luck. I'm so sorry for your difficulty and I feel your frustration.

The Early Intervention program in NJ only covers kids until their 3rd birthday. You could try the school district - just write a letter to the Director of Special Services indicating your concerns, they are then legally obligated to meet with you within 20 days of receipt of your written request to listen to your concerns then determine if further evaluation by the Child Study Team is warranted. Unfortunately, if the ONLY issue is expressive language, he will most likely not qualify for special education services. Under the NJ code, to qualify for services as a preschooler, he would have to have a 33% delay in total communication (expressive as well as receptive) or a 25% delay in 2 or more areas (cognition, motor skills, etc). There is a major gap in NJ as far as the "ease" of ability to obtain speech services for children when they are 3 and under who can receive Early Intervention, and children who are school age, and can qualify for speech therapy only and do not need to undergo full evaluation by the Child Study Team. Unfortunately, the children who are between 3-5 must have severe delays to receive help - and that's the most critical time to get help. Doesn't make sense!!

As far as the insurance company, 60 consecutive days sounds a little odd. I would definitely call to clarify!

Good luck!

Hi L., my daughter was 3 1/2 when she started her speach 2 x's weekly. Shehad several ear infections before her tubes were placed at 3 yrs old. Her hearing had been impaired or muffled by the constant fluid. After the tubes, it still didnt get better so-we did speach. We went to Marys place pediatric rehab. Her therapist was Miss Jessica. She worked wonders. She was leaving off the other half of the words-then just endings-then she was reaching her benchmarks. We have Aetna also. Check because ours is 60 visits in a calendar year. My little one didnt have any friends in her nursery school because the kids couldnt understand her and would tell her to go away. The teachers couldnt understand her either. It is frustrating. I know. Now the kids go to her to play. Her teachers said she is so clear now. When your dealing with the insurance, call back more than once. Half of them dont know what they are talking about. Your speach place should be able to get an answer also. Take care, K.

L., My girlfriend's 2 1/2 year old daughter is speech delayed and she has a speech therapist that is covered by early intervention. I am not sure what that is but I can speak to her if you want and see what she does. If you want me to ask, just email me back. Take care, A.

Hi L.:
We go to St John Neuman church in Mt Laurel, used to live there too! Now we live in Westampton. Anyway, I can't give you advice on insurance companies, but have you investigated the Child Study team in the Mt Laurel school district? We have utilized similar services in Westampton for our son with speech since he was 3 1/2. He is now in second grade. You can have him evaluated and if he qualifies, he would receive services for free through the school system. We have been happy with the services we have received, and I'm sure Mt. Laurel is very good too. Good luck! S.

L.,
These services should be covered through your county's intermediate unit. It may take some perseverence, depending on your county, but it is definitely covered!

The county will evaluate him and give recommendations based on his needs (FYI - most blends and r are sometimes not aquired until the age of 8. This is considered normal). My son is hearing impaired and it's a fight to get the right services, but it is your legal right. Do not be afraid to advocate for your child, and if necessary, there are advocates out there who can help you.

Good luck!

Warmly,
T.
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