Special Needs, Special Costs

Addressing your child’s special needs can be emotionally and physically draining. More often than not, it can be financially draining as well.

Little Stapler is still fairly little compared to his peers. Whether it is due to his metabolic makeup or his overly-sensitive eating is an unanswered question. What we do know is that our little guy had some special needs as a result.

He started seeing an occupational therapist in January this year, to help him gain more core strength and cross-body coordination. We had initially had him evaluated because he had extreme reactions to certain sensory input, and suspected a Sensory Processing Disorder. Although his evaluation revealed sensory processing issues, it didn’t rise to the level of the disorder. His occupational therapist worked with him on his strength, coordination, and sensory processing challenges.

Each session was billed at $195.

Our provider was out of our health insurance network. There were no in-network providers within a 45-minute radius of home. Our provider was allowed to “balance bill” us the difference between how much our insurance paid them and the the full-price cost of the service. Long story short: Yes, they are allowed to “balance bill.”

No matter, we still had a $5,000 deductible to meet.

I had an outpatient surgery scheduled for the spring, so I knew we would meet our $5,000 deductible either by little cuts (the OT appointments) or on the day of surgery. So, paying the $195 each week wasn’t too painful.

Once we met the deductible, however, our health insurance started to deny the claims.

They denied the claims because they aren’t obligated to cover treatment for “developmental disabilities.” Although Little Stapler was being treated for three issues, the provided coded his treatment under the sensory processing issue, which is considered developmental. Long story short: Yes, they are allowed to deny based on developmental issues — for now.

Solution: Our provider updated the claims to reflect the therapy for increasing core strength and our health insurance approved them.

Even after we met our deductible and our insurance began covering the majority of the cost, we were charged 30% of the cost of the visit. That’s $58 a week we continued to spend on Little Stapler’s occupational therapy. Plus, we drove 30 minutes every afternoon, in terrible traffic, just to get there. Needless to say, my little chatterbox and I had some interesting conversations during our long drives.

Sometimes, after a tiring day at work, I had to say, “buddy, can we listen to some music?” Adding OT on top of our other parenting responsibilities wore me thin, and he was only going once a week! I can’t imagine how working moms get their kids to their OT appointments more often than that. On the emotional side, we had to turn down playdates and forego certain afterschool activities because Little Stapler had a standing appointment each week.

On the bright side, Little Stapler loved OT! Turns out, it costs so much because we were essentially paying a highly skilled person to play with him for an hour on the most awesome equipment ever. He would go from the trampoline to a zip line to a ball pit, to crashing mats and a “squeeze machine,” which helped him calm down. (I wonder if I should get one, myself!) Tuesdays were Little Stapler’s favorite day of the week.

The therapist also recommended some equipment we could use at home. If you have a child with special needs, or you’re a special snowflake yourself (I know I have my quirks), some of the equipment that is available will blow your mind. My world opened right up when I found all of the different things we could get for helping him stay in his seat (hello balance ball cushions!), things to fidget with, chewable jewelery, and — the motherlode — weighted blankets and stuffed animals. Mr. Stapler actually bought a weighted blanket (he’s a special snowflake, too!) and sleeps so well with it, he was a little panicked that he couldn’t take it with him on vacation.

I even tried my hand at making a weighted stuffed animal for Little Stapler. More on that, with photos, to come. If you know how to hand sew, you can do it, too. I mean heck, with $59 a week going towards his OT, there wasn’t a lot left over to buy a $30 stuffed animal. At the same time, we bought equipment we couldn’t DIY because we felt we should position Little Stapler for success with his OT.

Now that Little Stapler has met his OT goals, it is a relief to no longer have that weekly $59 payment. And Mr. Stapler is lobbying for a trampoline.

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8 thoughts on “Special Needs, Special Costs

  1. Special needs can be pricey, and the thing that infuriates me is that insurance will often deny claims as long as they can– even totally valid claims, just because they think people won’t fight it. It’s often only people with a lot of time on their hands (which is no one) or those with high powered resources like lawyers and advocates who are able to fight the denials. When you’re an overtired mom to a special needs child, it’s painful to go through that process. And for parents living on the poverty line or working several jobs with no time to cut through the red tape, forget it. I’m glad the therapy company worked with you to get Little Stapler the help he needs, I wish more companies were like that! And great news for placing out of it, he’s lucky to have a mom like you who got him the help he needs to be successful. Getting help early is SO key!

  2. So happy for Little Stapler that you guys were proactive and got him assistance to get where he needed to be (and he liked it!). And that fidget toy might be making its way into my cart. I’m a fidgeter during conference calls :). And I totally get weighted blankets!

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