speech people

[houseelf]

I know that several of you have talked about your kids' speech needs. I am interested to know who pays for their speech therapy.

We pay $125 to 140 per session to attend weekly speech therapy. Insurance deems his particular language deficiencies as educational so they pay nothing.

I was told that when he turned 3, the local school district will take over his therapy. DS turns 3 in six weeks. After forwarding records, multiple phone calls and emails, I spoke with the district speech coordinator today. She said after reviewing his records, the district would test him and do a small amount of intervention but since his deficiencies don't render his ability to learn, we would have to furnish the vast amount of his therapy privately even though multiple experts have stated that he needs continued therapy. In lay terms because he can comprehend everything but can't be understood, it isn't an educational impediment. Riiiiight.

So, oh veritable fount of collective iMSN wisdom, how do I get insurance or the school to pony up? What is my game plan here. At a minimum, I'm tempted to see if I can get his current therapist to moonlight by paying her straight cash under the table at my house. I'm sure she is under a similarly obnoxious noncompete clause that constrains my husband, but the thought has crossed my mind.

[diggitydot]

Hmmm...I'd probably take him to the district screenings and not mention his diagnosis until after they deem him as having "special needs" requiring early intervention. That's what we did with DS. .

FWIW, I have a good friend who does speech/language therapy via Skype. Let me know if you want her info. She rocks and is a med spouse.

[moonlight]

We aren't there yet. DD is 2.5 yr old and in speech since she was about 20 months. I remember at the time the ST said my insurance just changed the rules and her speech delay was new an acceptable billing code. Other wise there were going to code it something different so they would pay- and I was fine with that. Thankfully the rule was changed and we didn't need to go that route.

When we were at the hospital clinic they billed $249 per visit. I paid 20% of that. I changed our provider this calendar year to a state program for children under 3yrs old. I think most of the kids are on medicaid in the program. Our provider has a contract with the state and she runs her private ST business. It's business of 1 person (her) and she bills my insurance $80 per visit and comes to my home. I then pay 20% of that.

How much are you willing to pay? Have you shopped around? Can you get the pedi to aid in changing the speech code? Can you bribe your kid to totally muck up the school eval? Ok, kidding with that last one!

[PrincessFiona]

Total Suckage, Kelly ... don't get me started. Certain person here got speech therapy free for years with 2 children via MNCare. It isn't free for those of us who pay outrageous family deductibles on our Cadillac plans (that also don't' cover it either). Shit ... I've injected politics again damnit.

I hate to suggest dishonesty, but ... figuring out what IS covered by the school district and why is a good first step. He will be 3 which makes him eligible for help through the school district. Could it result in an IEP plan? yes. Any way you look at it, there is ick. I understand your hesitation to accept school district help and giving up part of his educational planning to the schools. I opted against it. You know where that got us with Andrew.

There are no easy answers. I hope and pray that his speech issues are an easier fix and that you won't be facing years of payments. It's so not fair, especially when I know people who are getting it for free. :/

Kris

[Gwendolyn]

Sorry it has taken me so long to reply. We have done much speech in 4 different states, 6 different school districts/state programs and public as well as private. There are several moving parts to your question and it is overwhelming if you are just getting started. Honestly, it has now taken me 7ish years to sort this out and feel confident that we've got the best mix going and I'm still in a constant state of re-evaluation.
We are in a bit of a different circumstance because DS1 has hearing loss and the speech delay is severe enough that he easily qualifies several different ways, however we have abandoned public education and are in a private school. DS1 attends the private school, but still receives services from the district, like assistive technology and speech therapy. He also sees a private speech therapist at the school.
DS2 does not have any hearing loss, but has a diagnosis of developmental speech delay and also sees a private speech therapist. I opted not to have him evaluated by the school district for free services for a few reasons. #1 we were having a terrible time with DS1 when DS2 turned 3 and I did not have a lot of confidence in the district. #2 we had a wonderful private therapist that billed insurance. #3 while his delay was pretty severe he would not have qualified for much therapy (way less than he needed) through the district, so rather than piece-meal district and private, I decided to streamline.
So, I agree with Kris. Find out what the criteria for qualification is. Not to cheat, but to understand what you are getting into. Many school districts require one and a half or two standard deviations below the norm to qualify (every district is different though), which can be pretty severe. For a three-year-old that is a kiddo who most people can not understand. Then, ask if he will need an IEP or 504 to receive services. An IEP is stronger but can carry some stigma for parents. We have enjoyed the legal protections an IEP has to offer, but it is it's own set of rules to learn. Decide if jumping into the meetings and maintenance an IEP requires is worth it to you. If the hassle is worth the services they can provide, go for it. Free is free and therapy is expensive.
If you feel that the services offered through the district are not for you or you would like to supplement them, then you need a private therapist. The school or your pedi can supply a list. There are many different ways to deliver speech therapy and asking potential therapists to describe their philosophy and how it will address your child's issues will help you make a decision.
Call your insurance company and ask them what (if any) speech therapy is covered. How many sessions and at what %, as well as the difference between in and out of network. If they give you a number of sessions available per year or month ask how many minutes are in a session. You can try to maximize your coverage by taking the full covered 60min until benefits run out and then drop to 30min out of pocket. Also ask what diagnosis is covered. They can't tell you the billing code, but they can use the words that you repeat to your pedi and s/he I'm sure would be more than happy to make sure the diagnosis code is compatible with receiving coverage. This info should give you a budget to decide how much private therapy you can afford and then revisit what the district is offering. DS2 just ran out of insurance coverage and that was April. He goes twice a week. Full $84 X 2 per week X 7 months. Urgh.
DH has an FSA (flexible spending account) for medical expenses that we contribute the full $5000 to a year. It is still out of pocket, but it is a tax write-off and it is budgeted over his 24 paychecks so it doesn't hurt as badly. I submit an invoice and I am reimbursed within a week via direct deposit, so I can pay the therapist right away.
Now, this is going to sound crazy, but our big perk of post-training is being able to afford an FSA and the freedom to find a therapist that is a great fit for our kiddos needs and not rely on (or be beholden to) the school district for therapy. It is expensive. Before now (we've been out for two years) free through the school was the only option. We have had wonderful speech teachers that way, but we were often fighting for more, longer. Districts are strapped and it is taking more and more just to qualify. Also, if you do qualify, you don't have any say in how or what therapy your child receives. This may be great or it may not be great. At one school DS1 got 15min three times a week to make up his 45min a week. By the time he left class settled in speech he would have 5ish minutes before it was time to pack-up and head back to class. A supreme waste of time. However, his current district therapist has been his biggest advocate and support through some pretty dark days. Sadly, she is retiring early basically because she is burned out with a caseload of 100+ students and three schools that she travels among.

Anyways, I could go on and on. Send me a message if you want to chat more. Know that you are doing a great job by even starting the process. You have the right to ask as many questions as many times as you need to or want to from all the people (insurance, district and private therapists) involved in your decision. Good luck!

[houseelf]

Gwen!

Why, hello, hello! Let's chat.

Your post is wildly informative because this whole process feels like a labyrinth between the insurance company and the school district. Insurance refuses to pay a single dime because his deficiency is deemed educational. The schools state that he has to have a severe speech disorder in order to provide him services. His receptive language inventory was borderline and his expressive language is mildly to moderately impaired. He talks up a storm but no one can understand him. It is like he is speaking in Romanian. He has multiple phonics missing: all s-, s-blends, z, th, some f and g, and he doesn't properly "cap" the end of his words. (e.g. Nadaga = snake in the grass).

I had no idea that speech wasn't freely offered via schools anymore, even for several school aged children I know who have lisps and other garden variety speech deficiencies. This chaps my lilly white bottom like you wouldn't believe. I am a graduate from a decent school district and received 5 years speech therapy through the schools. My brother, a vice president for Microsoft, received 6 years of school funded speech therapy. If this issue comes to a head, this may just become my personal cause. I'm pissed off enough to make some noise. I also have a sneaking suscipicion that because we have demonstrated an ability and willingness to pay, the powers-that-be are going to be more than happy to foist it onto us personally. If my kid requires 5 years of speech, our out of pocket expense will be $40,000. In my mind this means scads of children are not receiving the basic services they need.

Don't cross mama bear. My claws are unsheathed. You all can attest in an interview, "Oh I knew she was going to crack...She was always sort of half-baked". Ha ha.

[Tenacious_D]

Bullshit on the severe disorder. We are in the process of getting E on an IEP for speech and they tried to wiggle out and we wouldn't let them. Get an advocate who understands your system. Parents do have a lot of power but have to know how to use it. I'm in my iPhone but I have some more tips. My FIL is a former special Ed specialist and a long time superintendent of schools...he helped us tremendously.


Danielle

[diggitydot]

Bullshit on the severe disorder. We are in the process of getting E on an IEP for speech and they tried to wiggle out and we wouldn't let them. Get an advocate who understands your system. Parents do have a lot of power but have to know how to use it. I'm in my iPhone but I have some more tips. My FIL is a former special Ed specialist and a long time superintendent of schools...he helped us tremendously.


Danielle

All sorts of this. Get an advocate. The district is trying to weasel out. Also, read up on federal laws pertaining to special education services. They may be out of compliance and need an attorney to ever-so-gently remind them of their responsibilities.

[ides]

It depends on the state & district sadly. In nyc we had to fight for O to get therapy. With just not speaking at 2 yrs but understanding everything he wasn't delayed enough to qualify. We had him re evaluated a few months later & the evaluator fought for us due to the fact he had problems eating too which they normally ignore. The city/state dragged and dragged their feet and eventually we got the minimum of services for the six months before we moved. It was under the early intervention system since he was under three years old.

He still has some speech issues & his preschool thinks he needs more speech therapy. We are now going through the school system for evals however by the time he is deemed to be given or not given it will be summer, when they don't work & in the fall we will be moved. I know its less difficult to get services in nm than nys but I'm not sure he would qualify. However since we will be moving we will have to start the whole damned process all over again.

From what you described it sounds like your child should qualify. Between the ages of three & four they should be able to be understood by strangers when speaking.

[diggitydot]

No matter what, get that IEP before you move. The new school is legally required to honor all incoming IEPs on new students.

[Gwendolyn]

All sorts of this. Get an advocate. The district is trying to weasel out. Also, read up on federal laws pertaining to special education services. They may be out of compliance and need an attorney to ever-so-gently remind them of their responsibilities.

It truly depends on the state and the district. Washington state is abysmal in their services, so the qualifications I described are on the lower end. In Wisconsin it was easy to qualify, but how he received services was tricky. In Utah, he got plenty of speech, but they were taking him out of library and PE...Honest to God I could write a book about all of the mama bear crazy I have had to visit over three states and five school districts. We've used lawyers, advocates, mediators, private Ed psych consultants, etc. We've moved to get into a better neighborhood and after two classrooms, lawyers and being accused of slander last year, we've decided public education in Washington is so toxic no amount of fighting will provide DS1 (my only school-aged kiddo) with the basics. Im not saying this to tell you to give up, if speech were our only issue, we might still be at the school. It was just the best choice for our child to move on. Im saying be prepared to fight a lot. It is a huge immovable system that doesn't do well with accommodating anything other than the norm. The more info you have from everyone the better. Ask again and again and talk to as many people as you can. I e found relentless is a powerful tool. Discover who seems to want to help and keep them on your side.
For sure check out an advocate. There may be some free ones through a non-profit or you may need to pay a fee. Oddly enough, the school can help you find one. It says something to them that you know how to ask for one and that you are asking for a referral to and advocate, not a lawyer. Don't be afraid to use a lawyer, but leave it to the end. In my experience, leaping to a lawyer means you will always have to use one to get anything accomplished, which can be just as expensive as having paid for private speech in the first place.
I have a PhD in arts education. I've worked in public school for years before I stayed at home. My family is chalk full of teachers and special education teachers and a few of them have doctorates in special education. The part that truly infuriates me is if we couldn't make it work, how on earth is anyone else supposed to? By the end of last year I was in meetings with someone about 10 hours a week. I could because we can afford for me to stay at home. How does a family with two working parents advocate like that? When I was working, I couldn't. We enjoy a very generous income so we could find the perfect school and hire an army of private specialists to see our kids there. 99% of America can't do that. So they are just SOL? Again. I could write a book. So very angry still. I can at least talk about it without shaking and ending up incoherent now a year later. Clearly, I'm not able to resist the soapbox though!! Sorry

[diggitydot]

WA is weird and each district can be so incredibly different from each other. Hell, each school within the same district can approach things in completely disparate manners. It's mind boggling.

My sister, cousin, and several friends are teachers in WA and my aunt is an elementary school principal in SW WA. Their buildings all have different approaches to students with special needs.

[Gwendolyn]

WA is weird and each district can be so incredibly different from each other. Hell, each school within the same district can approach things in completely disparate manners. It's mind boggling.

My sister, cousin, and several friends are teachers in WA and my aunt is an elementary school principal in SW WA. Their buildings all have different approaches to students with special needs.

So true. Of all that I truly love about living here, the school system is miserable. That's not to say we didn't struggle in WI and UT, just that it was terrible enough here that we've given up

[Gwendolyn]

And I should add, for all that it does to subject students to an awful education, it does the same to teachers and specialists who care about providing quality education.

What is strange is that it is one of the rare states where funding comes from the state level, rather than the neighborhood/property taxes level. Mostly, this is a positive thing that ensures equal education for all families. In the end, it has just ensured that everyone is struggling miserably and schools that can find a way to special funding (federal support, innovation grants, extraordinarily wealthy parents...think Microsoft, etc.) do better. So one school with a lower teacher/student ratio, a librarian, PE teachers, art and music can be down the street from a school that has none of the above.

Anyways, learning all of these kinds of ins and outs will only help your ability to advocate. We had to be pretty aggressive in Wisconsin too (advocate, mediator, lawyer), which is at the top of the lists for quality public education.

[diggitydot]

Holy shit, G. Now I'm curious which district you have been dealing with.

My sister's district in SW WA has a great tax base. WA schools do base part of their funding on property taxes in the form of education levies and taxes on businesses. Communities with a wealthier population and some decent-sized businesses in the mix have far more resources and tend to have better professional development for their faculty. However, because levies are voted on in each district, some go for a very long time without passing. They also used to have to overcome a super-majority (60%+) to pass any levies, but I think that has changed.