5 Steps to Getting an iPad Covered by Insurance:A mom's story of success
by Guest Contributor - Dawn Sconfienza Gaita
As a parent of a child with special needs, I understand firsthand
the financial struggles that come with the job. When I discovered the
iPad and the benefits it could have for my son, it became my mission to find a
way to provide one for him. This is a simplified version of the steps I
took in getting my iPad covered by insurance, and it is my hope that others can
benefit from this information.
- Check your medical benefits for
your "Durable Medical Coverage." (Mine covered 50%, but
since we had already met our out-of-pocket max, they covered at 100%)
- Phone your insurance company and ask,
"Please assign me to a case manager that is experienced with special
needs children."
- After you are provided a case
manager, explain that you need the iPad as an augmentative communication
device INCLUDING the Proloquo2go App (or TouchChat, OneVoice, TapToTalk,
etc.) Provide comparison costs to a more expensive system such as the
Dynavox, and remind them that you are opting for a more cost-effective
device. Focus on Proloquo2go (or your chosen Aug Comm app) and that
is being introduced by Speech Therapists and OT's in public schools for
special needs kids as well as in private therapy, say nothing negative at
all. If they have never heard of the Proloquo2go program, ask
for their email address to send them a link and/or encourage them
to visit the proloquo2go website. You could also provide
links to the Youtube demonstrations provided by proloquo2go (or app demos
provided on a4cwsn.com). Be sure to ask the case manager for all the
necessary approval codes and coverage information so you are aware and
comfortable with any out-of-pocket expenses you may incure. They
may tell you "NO" at this point. If they do, ask them to email
or fax you a letter of denial immediately. Local Developmental
Disability Divisions/Boards and many private funding organizations will require
a medical insurance denial to apply for funds, so getting this letter can be
very helpful. Don’t get discouraged, there are still more ways to get
funding!
- Find supporting documentation and case studies to include with
your claim. Google articles on "iPads for children with
special needs" or "benefits for children with [your child's
specific condition] and iPads," etc.
- Copy your most recent speech evaluation and IEP if it
indicates anything helpful. And, have every doctor, therapist,
school personnel or anyone else write a letter supporting your child's
need for an "Augmentative Communication device such as the iPad with
Proloquo2go."
The more information you can provide, the less likely
they will argue against the need. My personal insurance
required that I pay for the device and then submit a claim form for
reimbursement.
When submitting your Request for
Approval:
- Include a cover letter explaining what you would like to
purchase and why. Explain how it will be used and what benefits it
would provide your child.
- Supporting Documents from Google, etc.
- Letters from Doctors, Speech Therapists, etc. expressing "Medical Necessity"
- Receipt of the Device and the AugCom App
When submitting your Claim for
Reimbursement:
- Include a cover letter explaining 1) What you purchased,
2) What is was for, 3) How it should be coded and 4) That it should
be treated as an IN NETWORK provider.
- Include the notes (Name and Dates/Time of phone calls) from your
conversation with your case manager.
- Supporting Documents from Google, etc.
- Letters from Doctors, Speech Therapists, etc.
- Receipt of the Device and the AugCom App
Sample letters of recommendation for providers:
School Speech/SPED/OT
Physician- Letter of Medical Necessity
Clinical/Private Speech Therapist
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