Hi There,
Thank you for the welcome AngelaVA! I am sorry to hear of all that has happened to your little one. It sounds as if you've become familiar with the "system". I understand exactly what you are saying and we've explored all of the codes. Unfortunately, my insurance company is very "strict" on the interpretation of the codes such that even in the initial ICD-9 code that was utilized would not place us under the Neurodevelopmental benefit, as his symptoms shape up to be neurodev in nature, they would then place his interventions under that ND benefit and cap us at the age of 6. Our OT says that she's running into this all the time.

Our original dx was 312.9 (disturbance of conduct), which doesn't scream neurodev, but due to the fact that we did not have an injury(although it was a traumatic birth that landed me in the PCU/ICU for 10days) or illness that precipitated "I's" sx that we can point to as a cause, the insurance company will stand firm in cutting our benefits at 6yo. It leaves us with three options, pay privately, move to a state that mandates coverage until the age of 18, or don't get him help. There needs to be legislation passed in our state (Washington)- so anyone working on that, I'm happy to help. Until then, my husband is talking to his company to see if somehow they can negotiate coverage as a part of their package. The company has the clout, we don't.

It feels all so arbitrary....when the stakes are so high and kids can improve with therapy!!! Just the few interventions we've tried that the OT has suggested, brushing for example, have made a difference. He was even able to wear a short sleeved t-shirt for half a day! Wow- seriously. Such a small victory, but a victory nonetheless.

Thanks again for the welcome- it's good to know y'all are out there.

Peace-
AJINE