Friday, July 29, 2011

The cost of therapists for kids with special needs: Let's compare!


I try not to think too much about how much we shell out for Max's therapy, because obviously that is the most financially responsible thing to do. Right. Really, we don't have much choice. He needs extra speech and occupational therapy sessions at home, besides the ones he gets at school, especially while he is still young. An so that's priority spending in our house.

The insurance company pays 70 percent for speech therapy, but has been bouncing back all of the occupational therapy bills because supposedly it's not covered under our plan. (Which means we're in the process of trying to figure out which diagnosis codes will work.) I've never bothered trying to get reimbursed for music therapy because for sure we would get back an Explanation of Benefits that read "You've got to be kidding."

What we pay for Max's therapists (we're in the metropolitan NY area):

Speech therapist #1: $110 for 45 minutes
Speech therapist #2: $110 for 1 hour
Ooccupational therapist #1: $100 for 1 hour
Occupational therapist #2 (who's part of a practice): $155 for 1 hour
Music therapist: $100 for 1 hour
Art therapist (more on her another time, just found her!): $100 for 1 hour

A few weeks ago, we met with an occupational therapist who works for herself and who charges $155 an hour. Sigh. But then again, good OTs and STs who come to your home are at a premium and because I work, we have no choice but to use them.

Hey, I've got an idea! We should start charging the kids for all the therapy we do for them! Max, you owe me millions.

OK, what do your child's therapists charge?


Flickr/Brockney52

40 comments:

  1. Hippotherapy (horse!) is 85/hour. But this is non-profit organization. In reality it costs them $200+ per hour. Besides the benefits he gets from being on the horse and learning to follow directions, etc, his therapist is a speech path. The main goal is improved communication shkills. It takes us about 30 minutes to get there, so this is really apart of the cost too. Now that Luke is 8 he is able to have an early evening session so I don't have to leave work early (a big plus).

    OT for feeding/sensory is $120/hour. The feeding part could be done at home, but not the sensory. They have a fantastic sensory room with a trampoline, various swings, a rock climbing wall, zip-line, etc. This place is only 2 miles from home, but they have fairly tradtional bussiness hours so I have to leave work early. It is Lukes MOST favorite place in the world.

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  2. 1x/week: Hippotherapy (she is also a great OT) is $40/hr (not covered by insurance).

    Speech (when we had it) was ~$100/45 min. (covered)

    1x-2x/week: PT is $120/hr (covered)

    2x/week: Feldenkrais (we buy "bulk sessions") is $80/hr (not covered)

    We also have community classes, which vary from $45-$80/hr (not covered).

    After E's rhizotomy, we had 6 sessions of varying therapies per week--it was nuts. Thankfully, due to Medicaid (my insurance covers ~no therapy) most of it was paid for, and we got to keep our house.

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  3. A recent insurance statement says that OT bills $533 an hour, and the insurance allows $165. We've used all our therapy benefits through our regular insurance for the year, so a state-wide program for special needs kids is paying for them. (thank goodness!) I'm told there's a cheaper rate for paying cash, but who knows....

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  4. Thanks for asking this question, Ellen. I'd also be interested to know, if your insurance company covers therapy, what is your copay?

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  5. I'm in Hong Kong and go to the public hospital for therapy for my daughter. She currently only does OT and PT - for the grand sum of $8 per hour. Yes, you heard me, $8!!

    IF we were going to private therapists though, it would be anywhere between $100-$200+ per hour though.

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  6. We adopted our son through foster care and therefore state insurance stays with him until he is 18. They pay for most of our therapy. We do pay for hippotherapy at $85/session and we will be doing an intensive speech therapy program next summer that will be around that same cost. I struggle with figuring out how much therapy to do, especially with my son just entering full day kindergarten next month. I think he is going to be pretty wiped out after school so I'll have to see if he has any energy left to give for additional therapy, other than PT that we will for sure continue.

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  7. Oh good grief - talking about insurance and co-pays and deductibles makes my stomach hurt and my blood boil.

    My daughter is in full time behavioral therapy (ABA) right now (40 hours a week in a clinic setting) and while we could opt to do a $60 copay every day she is present at the clinic, it was actually cheaper in the long run for us to not utilize the copay option and just pay in full ourselves so that we could more quickly meet our deductible and out of pocket expense of $18,000 (holy stinkin' cow!) and now our insurance covers 100% of the expenses. Of course, that will all end in a few short months with our insurance company's fiscal year and we'll start over paying in full again. Sigh...

    FYI - A totally non-insured child would be charged $10,500 PER MONTH for 40 hours of ABA therapy at the clinic my child attends. Can you even imagine???

    I'm about to add music therapy (not sure of the cost here yet) and OT (with insurance co-pay, around $125 per session) to the mix of expenses as well.

    It is just crazy expensive..... but I don't want to skimp on what I think my child needs....

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  8. Kadiera & Julie: So awesome your state pitches in. Ours stopped after Max aged out of Early Intervention.

    Amy: Amen for Medicaid. We haven't gone there yet.

    Janet: That sensory room sounds amazing, like it could be Max's favorite place in the world, too.

    Nicole: Moving to Honk Kong isn't so feasible for us but after reading that, I'm tempted! How is the quality of therapy there? How does the approach differ, if any way, from that of North American therapists?

    Galen, none of the OTs and STs we use are in the network, so there is no copayment. Insurance pays 70 percent for the speech therapists...and, right now, not one cent toward the occupational therapists.

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  9. Right now our PT through EI bills out at $225/hr and our OT the same. D gets 1 hour of PT a week and 45 minutes of OT a month. Insurance/EI cover 100% of the costs. We also do 1 hour of private PT a week at $140/hr, but again insurance covers 100%. For now, that's all we do, but we are thinking of adding ABM/Feldenkrais which I've heard they'll cover as long as it's not on PT days.

    As soon as he gets off the wait list, we'll add hippotherapy. Insurance won't cover that at all and I'm pretty sure it's ~$150/week, not to mention the gas/time since it's 45 minutes away.

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  10. I'm just curious whether or not most people's insurance covers PT for cerebral palsy. We recently switched from United Healthcare to HealthNet. United used to cover up to 20 sessions each of PT, OT and speech. HealthNet denied our request for PT sessions for Zac because they said it as not "medically needed" for CP per their "national medical policy".

    This seems totally crazy to me. Does anyone else have HealthNet?

    Also, I can say Hippotherapy in Tucson is $100/hour and also not covered (either by United or HealthNet).

    Kevin

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  11. Not sure if anyone heard about the legislation that Kentucky passed recently that puts a limit on copays for therapy, tying the amount to the copay for a specialist. Many insurance companies are paying less and less for therapy, for example, one insurance company only reimburses at $50/hour for therapy, and guess what the copay is? $50. So the patient is paying the entire bill...sweet for the insurance company. The Kentucky measure was supported by the state PT and OT associations.

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  12. We are fortunate to have great Medicaid coverage for kids with disabilities in PA, so all I currently pay is the copay for our psychologist who only takes private insurance.

    I have no idea if this will help, but when we did have some out of network OT, it kept getting kicked back and we finally found there was supposed to be an identifier on the end of the insurance code (it was 2 digits, not sure if letters or numbers), that indicated whether it was PT or OT and then the bills got paid per our contract. Of course it took months to figure this out!!

    Love the spaghetti therapy! I would love to get my kid to agree to even touch a noodle, but he is totally grossed out by the texture. :)

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  13. Kevin, therapy for CP not "medically necessary"? Outrageous. I despise insurance companies.

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  14. Galen, I know, it's insane.

    We have generally found that insurance will not cover cerebral palsy, a lifelong condition. We are able to use a diagnostic code of "stroke," which has worked at times, and sometimes not. Seriously, I think it sometimes depends on which staffer is looking at your paperwork!

    I have gotten insurance companies to pay for hippotherapy because the therapists have billed it as either physical therapy or occupational therapy, depending on what was done during the session. Otherwise, insurance companies may see that as alternative type treatments, which they typically don't go for.

    For the last insurance company we had, I requested that we have one dedicated staffer to work with. It made things a lot easier. Right now, I am trying out a service called Off Your Desk that handles paperwork for clients, for a fee. I will report back to you guys on how that goes.

    We need an insurance company staffer to jump in here and give us some scoop! Deep Throat, are you out there?

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  15. I'm in California. Water therapy at the nearby hospital charges $550 an hour. Insurance covers it after we meet our $7,000 deductible. We pay for private speech, which is $135 an hour (not in home). This is out of network so we pay 40% regardless of meeting our deductible. Then we get 20 free hours/month of inhome services through EI, which is divided between OT, PT and speech. Hippotherapy gets coded as PT, so is covered after we meet deductible.

    Julie Lewin

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  16. Well, do surgeries count? Because without insurance, we never would have been able to do a single thing for our daughter. The total for all of her surgeries and consults total in the $100,000's. With insurance the cost has been within our reach.

    She gets speech & PT and our co-pays for those are $50 a pop. Her hearing aid cost $3500 with consults and testing.

    It's smart to keep track of all your out-of-pocket expenses on your child's medical care, because it can be written off come tax time. I keep a spreadsheet of the costs throughout the year so that I have it all set and ready when taxes are due.

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  17. The whole diagnosis code thing was very frustrating for me and I still have some bills I am struggling to pay. Because until she got an MRI proving that she has a medical problem some entities insisted on using “developmental delay” which is not covered. Every biller knows that that code will bounce so why they insist on using it is beyond me.

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  18. Right now between insurance and Early Intervention, everything is covered except for the $200 we paid for a speech/OT camp this summer (3 hours a week for 6 weeks, taught by grad students). If insurance didn't cover us though, it would look something like this:

    School, 6 hours a week at $300 an hour: $1800 a week
    Speech, 1 hr a week at about $120 an hour: $120 a week
    OT, 2 hrs a week at $240 an hour: $480 a week
    Behavior, 4 hrs a week at I'm guessing $150 an hour: $600 a week

    That's in the ballpark of $2,550 a week, and that's just my older son. The younger gets an hour of PT, and hour of OT, and soon an hour of early intervention a week.

    I don't know what we'll do once our older son turns 3 and ages out of Early Intervention. Insurance will pick up some visits but after that I think we'll have to pause therapy, or only do one therapy a time. We're also considering moving out of state (we're in CA).

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  19. As an adult (27) living with CP, my therapy as a child was $160 per hour 3x per week. That was under my parents dual insurance. Now, my therapy, once per week is $120 per session, of which my insurance covers $50. I really can't afford $70 per week out of pocket, and even getting my insurance to consistently pay the $50 per week is often a battle. I'm often so inspired by the comments left by parents here...keep up the awesome work!

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  20. Oh Wow! You guys pay alot for therapy in the States. I'm in New Zealand and things are done very differently. We have a publicly funded health system that includes early intervention programmes. On the down side though we just don't have all the therapies available to us here that it seems you do over there.
    My son just has one hour per week with his SLT, physio and early intervention teacher all together (NZ focuses on a very holistic approach to education and therapy). So that's one hour per week all up (and only during the school term).
    So pros and cons to both systems I guess.
    I do feel very lucky though living in NZ as we do not pay for any of my son's health care and he sure has been a million dollar baby (literally), at least!

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  21. We pay the copay for aqua therapy $35(1x week) - we have an awesome doctor who wrties the aquatherapy script as medically necessary so they haven't faught us too much on it yet.

    I do hippotherapy with my son myself - obviously not as nice as when he had a true PT doing it with him but it costs me $25 for an hour of having the beginner riding instructor lead the horse aroud while I ride with Rhys and do his stretches (plus the 1 hour round trip to the barn and back) - so much more affordable this way -plus a great excuse for me to ride with him!

    Once we get his Eye Max up and running we will be paying another friend of mine under the table to help with extra speech and reading help - she is a licensed Speech Therapist with a Master's in Reading - $40 hour (she normally gets $100 hr for that work. Plus she is willing to work around my crazy work schedule.

    I think we are lucky in that we have great therapists in our area but not the super high prices of a city. We are in upstate NY so we have access to Syracuse and Albany if needed.

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  22. $168/hour for ABM therapy. And we drive 4 hours to get there.

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  23. Kevin-do you know what code is being used for your child's therapy? I'm an OT (in IL) and we have to make sure we bill for what is being treated rather than the diagnosis itself (i.e., developmental delay rather than CP). Good luck!

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  24. I live in Canada, and in our small town, we deal with the Child Development Centre until O starts school - we get ST, OT, PT & infant development. When he starts school, the Government has the at home program which covers in-school therapy. Great you would think, but we can go weeks without seeing a PT or other therapist, on account of holidays, sickness etc! Unfortunately there are hardly any other private pediatric therapists in our community, or even nearby. Larger cities, they range about $120 for main therapy. We see an accupressuist for $25, and we drive 5 hrs down to the States (Seattle) to see an ABM at $90, fly to California for another ABM at $175, and see a somewhat local feldenkreis practioner for $90. My husbands extended medical coverage pays for 80% of most therapist - we just have trouble finding ones that our close..

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  25. We're a military family, so our medical bills are nonexistent. Really. Connor racks up about 3,000 dollars a week in medical bills, but the army covers everything, including the little guy's formula and our respite care. The only time we have a co-pay (three dollars) is for his medication, and that's only if we get it off post. Connor to date has racked up over $1,300,000 dollars in medical bills, so this is a very, very good thing.

    Of course the military comes with it's own big issues, like the one where my husband contributed his own (thankfully paid) 300,000 dollar medical bill after he was injured in Afghanistan. But we're extremely thankful for the military because with the insurance we'd be beyond bankrupt and probably having to make some difficult decisions about what therapies, equipment etc. the little guy would be getting.

    Good thing Jer likes the army. There's no way he'll be leaving it any time soon.

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  26. So no comment from a "Deep Throat" yet. Sometimes I think only trusted family members of persons who do medical insurance work know what they do.

    This is an interesting 'survey' of costs, Ellen. I won't draw conclusions from the comments. Lots of variables....

    I resist accepting your two statements about having 'no choice' however, Ellen. You may not like either choice, but you are choosing to be employed (no one is forcing you) and you choose to pay because you don't like what the choice of not paying means to your son.

    Choices are severely reduced when you have few to no licensed therapists - drive further, move cities - tough choices but choices nonetheless.

    Perhaps I am picking at semantics, but 'cost' of therapy is so much more than the number of $$$$. Barbara

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  27. This post by a mother in Australia might interest readers - although she focuses on the cost of equipment initially, she makes a point about funding all services.

    http://rollercoasterparenting.blogspot.com/2011/06/stopped-looking.html

    Barbara

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  28. We get our therapies at an awesome children's hospital, and they are skilled at manipulating the insurance system and coding stuff in a way that insurance will cover it. So we pay a $15 copay per session. Still, all those $15 sessions add up for us.

    What bugs me is that if Jack went to public school, some of these therapies might be provided free through school, and on school time. I don't think the public school therapists would be nearly as good as the hospital ones, but they wouldn't suck, either. But he goes to private school so we have to do them on our dime and our time. You'd think for what we pay that school they could throw in a little speech therapy here and there!

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  29. I own a therapy services company. Insurance contracts require that a provider bill the same, whether to an insurance company or individual. I've seen some providers give a sliding scale based on income, but I'm uncertain if this is technically ok to do. Insurance companies only pay a percentage of the billed rate, but providers aren't allowed to charge different rates for different levels of coverage. In our state, the difference in what's billed and what's paid is at least 30%.

    My input is that if you are going to private pay for a service and you have options, use a provider group that does not bill insurance, so that they don't charge the inflated rate. Ask about a sliding scale based on income or a reduction for prepayment.

    Be sure that the therapist you use is training you on home activities/exercises, to make the most of time spent outside of therapy. If you use a sitter or nanny, be sure that they get trained in the exercises too. I've found a lot of college students in elementary ed, special ed, and therapy are eager for extra work. Finding someone to be trained in follow through of a home program can increase the benefit you get and possibly allow you to reduce the frequency of sessions(and you take out the parent/child dynamic that sometimes interferes with parents doing home exercises). It's not a substitute for therapy, but using someone with a greater skill level gives you more benefit. Just my thoughts....

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  30. Excellent comment, Melissa.

    Barbara

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  31. Ellen -

    Our state chips in, but the program that does it has a crazy paperwork trail to get it set up, and a sliding scale fee for participation. Currently, my son has a medicaid waiver, and being on medicaid makes the program free. The cost of therapy is higher than our $3600 (lump sum) buy-in, so we'll continue it once we lose the waiver...

    They're the payer of last resort, after you've exhausted all other options, they only cover things related to the specific diagnosis you're signed up for, and there are some recent rules that cut way back on the equipment they pay for, and the travel expenses they'll pay.

    But....it's better than nothing.

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  32. Meghan - Don't know what codes they used, but I will look into that. Thanks!!

    Kevin

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  33. Kevin,

    I live in Tucson with CP since birth (I'm 36 now) and my insurance covers 1 hour therapy sessions once a week for 52 weeks. Although, I had to be on a waiting list for 3 1/2 years. I have APIPA.
    Also, I'm sure you looked into it, but there is a program in Tucson called TROT that offers Hippotherapy with horses, but here is some info. There are also scholarships if you are financially in need.
    http://www.trotarizona.org/sitebuildercontent/sitebuilderfiles/infopkt2011.pdf
    Let me know if you need anything. My email is wildcat2279@gmail.com.
    http://www.trotarizona.org/id35.html
    When I was younger I attended a center for the Neurologically Impaired in which my parents paid $700 per month (Monday-Thurs 3-7 pm which included OT, PT, Music, etc.)
    All you parents are inspiring!

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  34. Just to share what has worked for us in the past with my son who has autism. He does now have limited coverage under our private health insurance, but before he did, the OT used developmental coordination disorder and the psychologist used adjustment disorder. Both were approved as medically necessary and then paid at the standard rates for the service/provider.

    However, I do have friends who were denied from the same insurance company based on the developmental coordination disorder the following year, and their doctor copied the letter my son's pediatrician had sent in to justify the treatment.

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  35. When I had therepay it was either by Early Intervention or the school so it did not cost much. Now my siter is in OT b/c of a small stroke that afected her wrist it costs a $10 copay every session(3x a week)

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  36. I forgot my vision therepy that i used to have it cost 120 a session it helped at first but as i grew it stopped working and it was time for braces the vision therapy was not covered by insuranse because they said she has a hearing loss why does she need vision therapy? hello i have horrible tracking skills last year we were in a fight with the insurance people about covering her therapy as they thought only fat adults could have strokes and they could not happen under anthesia but we won!

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  37. Hi, I am interested to know what most of you (in the USA) feel is a fair price for private therapy. Considering the ones who travel to the home and those that are in a clinic setting. Thanks

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  38. Astrid, not sure how much response you'll get since this is an old post but I generally feel the fees we pay for therapists who visit us at home fair. We aren't seeing anyone in a clinical setting right now, so can't comment on that.

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  39. Hi, we are new to omaha, our 22months baby was taking 2x per week behaviour theraphy in hongkong. She was diagnosed with risk of autism just 2 months back. We aree due to meet the pediatric doc next week. But before than can anyone tell me as what to look forward and where in omaha. We do have a health insurance but still have to check if BT sessions are covered. Any help is highly appreciated

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  40. Vision Therapy? All of the exercises are great for everyone.
    Is this something you could do just as well at home from a book?
    Does vision therapy solve the problems?
    Does a vision therapist have skills and overhead that warrant the cost?

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Thanks for sharing!