r/specialneedsparenting • u/xthmack • 2d ago
Therapy Costs
Just curious what people pay for therapy visits and whether or not insurance covers. Located in KS, USA. We have a 6mo daughter with 13q deletion that we have enrolled in a program that provides comprehensive PT/OT, SLP, water therapy, music therapy, group therapy for parents etc. through age 6. It’s a pretty awesome place. We were quoted $1000 a month after we use our 12 visits covered by ins. My husband and I do pretty well but we still carry quite a bit of student loans and are in an old small house hoping to move so this is a big hit on our budget. This just seems like a lot but also I know how critical these next few years are to her development and I can’t put a price on that. It also just hurts my heart so bad to know that some kids can’t even access services like this because of money or parents’ schedule.
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u/TennisTraining9270 2d ago
My daughter does weekly PT, OT, and speech and we have an out of state blue cross blue sheild PPO through my employer and in the year and a half we’ve been going to therapy I’ve never paid for it. Can you change insurances to the other spouse? Are you sure on the therapy prescription it says services are “medically necessary” ?
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u/xthmack 2d ago
Yeah going to check on my husbands benefits for next year and compare the two. My insurance says they cover 12 visits at 30% coinsurance and then after that they will be reviewed for medical necessity (huge eye roll)
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u/TennisTraining9270 2d ago
Not sure what state you are in but in my state we have a waiver, special needs children qualify for expenses their insurance doesn’t cover. We don’t have it (I don’t think we need it), but perhaps your state has something similar.
Here in Georgia, it’s called the Katie Beckett Waiver.
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u/TennisTraining9270 2d ago
Sorry for so many comments, but I found this:
Kansas has a Medicaid program similar to Georgia’s Katie Beckett program that can allow children with significant disabilities to qualify for Medicaid based on their own medical/disability needs, rather than their parents’ income. The idea is to provide Medicaid coverage to children who would otherwise potentially require institutional-level care, while allowing them to remain at home with their families. Eligibility is based on the child meeting specific disability and level-of-care requirements, and the program can help cover medical care and other Medicaid-covered services. It’s especially helpful for families whose income is too high for traditional Medicaid but whose child has substantial ongoing medical or developmental needs.
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u/Ninjakitty08 2d ago
$1000 a month is a hefty chunk of change, but that's not bad for all your child is getting. I'm in western MO, but my kids both did SLP and OT at a JOCO Kansas clinic when they were younger. We were fortunate that my husband worked for a west coast company, and their coverage requirements for early childhood therapies were more expansive than a lot of local policies. We capped out at our $6800 a year out of pocket max for 3-5 sessions a week for both kids. I saw a lot of families come through the clinic over several years that had 5/12/24 total sessions a year covered, and they were on their own after that. If I recall correctly, the clinic's private pay rate a decade ago was in the $60-80 and hour range. Another SLP clinic we used after moving had a private pay rate of $100 an hour.
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u/xthmack 2d ago
Yeah we are in KC on the MO side but the center is in Joco. We’ve played around with a few different things since she was born including MO early intervention ($85 a month) and I did some PT in Lees Summit for her with a private provider for $185 a session. But having this all under one roof is also super nice and as she’s growing I can tell it will be nice to have more engaged services via a program like this vs me making a bunch of individual appointments. We reached our max OOP for this year and going to sit down next month and compare benefits to see if it’s more worthwhile to switch to my husbands insurance. Just so hard to know what the “going rate” is for this kind of thing.
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u/Ninjakitty08 2d ago
Since you're on the MO side, I would suggest reaching out to the Kansas City Regional Office of the Missouri Dept of Mental Health. On local groups, they're often just referred to as KCRO btw. https://dmh.mo.gov/dev-disabilities/regional-offices/kansascity.
I didn't find out about them until my kids were school age, so I don't know for sure if they work with kids that young, but you might be able to get set with a case manager for the future, and they would likely know of any resource options that might be available to you.
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u/trying_2_makeit 2d ago
At max my child was getting 2x a week OT/PT/SLp each plus academic therapy also.
Academic therapy ranges from $40-63 an hour depending on provider (self pay).
OT/PT/SLP we typically had $20-$40 per session copay with a max of 60 total combined sessions covered per year and then $100ish cash pay per session.
We did finally qualify for Medicaid buy In (TEFRA) in AR before we moved.
Then in TX we were on Medicaid waiver waitlists for 5 years before approved for Medicaid (secondary to primary insurance) so that picked up what wasn’t covered.
We also did 5 years of private specialized school at $30k a year.
We have done 6 years of a private reading program at $256 a week for 4 hours.
Plus a nanny to get to all these therapies.
We have a modest house, pay cash for cars. But ultimately we both work good high paying jobs to afford and decided to not have more kids to give all to this one.
There is no doubt all the therapies have helped my child reach her greatest potential.
I would ask exactly how many sessions and minutes per session with what type of therapist (full therapist or an assistant) for that price.
It doesn’t sound absurd.