Amanda asked: Hi Viviane, I am in the process of adopting and was interested in knowing about the therapies your son is receiving. How did you get the referrals? Is it through early intervention programs or private? If private, does your insurance cover any costs? We want the best for our child, but know that therapy is expensive and I don't know how we could swing it without insurance!
This is a good question and I should start answering it by saying that I am thankful every day for the great medical insurance we have through my husband’s employer. When we adopted Rex, we did not anticipate that he would have permanent disabilities and could not have imagined how incredibly important this fantastic health insurance would become to our family.
At the moment Rex is receiving two kinds of private therapy: OT through our local children’s hospital and ABA in-home through a private team I have assembled. Our therapy co-pay for a maximum of 60 visits annually at in-network providers is $15 each and the rest is covered by insurance. We have been paying for the ABA out of pocket since October (around $1000/month), but fortunately when Rex turns three, he will qualify for a large special needs scholarship in our state which will cover his ABA therapy costs through the summer and then pay for the majority of his special needs preschool fees in the 2012-13 school year.
Rex also received referrals for PT and ST. These referrals (OT, PT, ST) were made by our local International Adoption Clinic, but you could also get them from your pediatrician or other medical specialists. We tried ST for a while, private through our children’s hospital, but we didn’t feel that it was benefitting Rex yet and we simply cannot squeeze PT into our family schedule right now. When Rex does start preschool, he will have weekly OT, PT, and ST there.
As soon as Rex came home, we signed him up for early intervention in our state. They do not provide therapy, but do connect families to local resources, monitor the child’s progress, and bring in therapists from time to time to advise and teach the parents. The program has been most valuable to me in terms of helping me figure out some long term options. For example, we have signed Rex up for all available state waivers which means we have joined long wait lists to receive cash and other assistance. It will be years before Rex’s number is up, but when Rex is much older and his care might be more complicated, we will have those waivers in place and will be able to access them. Early intervention has also connected me with a Family Support Program which is income based. It offers families in our state funds to pay for things like respite care, therapy equipment for the home, prescribed special diets, etc. Through this program I am able to have a few hours of respite a week and have also purchased some therapy items, like a cuddle swing, for Rex to use at home.
With Rex’s impending third birthday, he is aging out of our state’s early intervention program. Therefore, with our consent, his case has been transferred into our local school district where an IEP has been completed for him. This IEP specifies goals and objectives for Rex for the next year. It also guarantees Rex access to our district’s preschool and PT, OT, and ST provided for free by the district based on their evaluation of his needs. However, we are not going to use these services from our district. Instead, we are opting for the special needs scholarship to send Rex to a private, specialized preschool. The scholarship money comes out of our district’s budget and paying it absolves them of any responsibility for Rex’s education beyond the annual writing of the IEP and the quarterly progress monitoring.
The best thing to do is to learn as much as you can about your local options before your child comes home. Have some discussions with doctors or therapists you might know, talk to parents who have kiddos with special needs, explore daycare options, see what your local school district offers and what alternatives there are. Find out coverage for services from your health insurance. Google and call and don’t feel stupid to ask a lot of questions.
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