Monday, November 14, 2016

Struggles of Speech

Teddy's the strong silent type. As in, he's rarely vocal. (And he's extremely strong for such a child with hypotonia. That kid has grip strength.) Teddy first babbled right around Easter with bababa and mamama. Since then, he's been hit or miss with his babbling. We struggle to understand his communication, and it's been a slow process.

We've been approved for speech therapy since Teddy was about 18 months. Speech has always been the last therapy to get approved. It was the first to be denied. It was the first denial to be appealed. And it was the first appeal to be won.

When Teddy got BadgerCare, Wisconsin's Medicaid program, approval for therapy got more complicated. Now both our primary insurance and secondary Medicaid must approve the therapy. Teddy gets the lesser amount of therapy approved. If primary approves 5 visits and Medicaid approves 3, Teddy gets 3 visits.

Apparently, Teddy starting school makes things even more complicated. He gets OT, PT and speech therapy in school, but I was told he could continue to receive outpatient therapy as long as he is working toward different goals in both settings. That seemed simple enough considering there's plenty of opportunity for Teddy to learn and develop, right? Apparently not because that gives insurance yet another reason to question and possibly deny his therapy.

Teddy's last speech visit was September 16 when his authorization expired. His therapist had everything set to go and submitted right away. Now, nearly two months later, he's approved for speech therapy. He gets a whopping 3 visits between now and mid-February.

Yes, after 2 months of waiting, he gets to see his speech therapist three times in three months. Then we'll go through this whole process all over again.

I'm not sure the point of this post other than to express my frustration with the medical system. Taking Teddy to multiple therapy sessions is not one of my hobbies, believe it or not. However, I recognize his therapists are educated professionals who are experts in their respective areas, and I am not. They have different ideas, techniques and approaches. Their assistance has helped Teddy make tremendous progress.

Good thing both OT and PT authorizations expire this month. I mean, who really wants to be approved for therapy during the holiday months?

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