Insurance

by Rachel
(Upper Darby, PA)

Are there any programs or assistance for kids with SPD? I am a single mom of two kids and my daughter has SPD. There are no OT providers within an hour of my house, at least that I can afford. Should she then by denied proper medical care? What's insurance for anyway?




The SPD Help Line Answers


Ah, the insurance issue… that can be a tough one. But, there are ways around it. First, I am wondering… do you have a SIPT certified OT you can go to? If you want to check for one in your area (where do you live?), go to: www.wpspublish.com; click on your state and it will bring up a list of OT’s that are trained in sensory integrative theories and treatment. They may be better at working through the insurance companies.

As far as insurance specifically, there are diagnostic codes that can be used and creative wording that can be done by your OT. For a list of commonly covered diagnostic codes, click here.

The problem with insurance reimbursement is that SPD is only recognized in one diagnostic manual at this point, so many insurances don’t “accept” that diagnosis. If other diagnoses or functional issues (which I am sure there are functional issues) are present, therapy can be provided through insurance if the right wording is used… an experienced OT should be able to accomplish this.

Until we get SPD into the DSM V, this will continue to be a problem, unfortunately. But, know that Dr. Lucy Miller and her team are diligently working on this. We hope it comes through. Right now, the only diagnostic manual it is in is the ICDL (click here for more on this). That’s a start. But, talk to the OT’s about some creative wording and how they can get the insurance to pay for it… just don’t use the words “SPD or Sensory Processing Disorder” as it won’t be covered that way (usually).

One more article that may help you is; Financial Help For Sensory Products And Therapies.

Hope this helps. Good luck.

Anyone else have any ideas? How did you get your therapy covered by insurance? Any OT’s reading this know any tricks? If you can let this mom know… she would greatly appreciate it, I’m sure!

Take good care.
Michele Mitchell



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Mar 08, 2008
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starstarstar 		Some Advice
by: Lisa OTR

You may want to consider going through your local Early Intervention program if you child is under 3 years old; OR go directly to the school department and request an OT evaluation. You do NOT need a SIPT certified OT to treat your concerns. I have been working in EI and school based for 10 years and treat children with sensory processing issues daily in both settings.
Most likely, your child is having sensory processing issues which are impacting his/her abilty to perform self care or play skills at age level, or their ability to fully access the school curriculum. Either way, an experienced OTR will be able to see what the sensory issues are impacting in terms of your childs roles and skills.

Hope this helps a bit.

Lisa

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