Monday, July 18, 2016

Restarting OT- copay or OOP

After foolishly stopping OT cold turkey when our occupational therapist in Pennsylvania retired almost a year ago, the effects of stopping Thomas's sensory diet are really starting to catch up to us.  We got complacent when things were going well, which is so easy to do with how busy life is.  Even though we learned how to do a lot of the therapeutic activities/exercises that help him, my husband and I decided to start working with an OT closer to us in NJ and address some of the sensory issues that are getting worse.

So we were faced with the issue of do we go the co-pay route through a system that has a broad OT focus or pay out of pocket (OOP) to go to a place that specializes in sensory processing disorder.  We were faced with this decision 2 years ago when we began OT.  Back then we decided to go in network, as I had recently quit my job to stay home full time with our two boys.  (See post from 2014)  They tried to get him into the loud, bright, noisy gym to evaluate him with no luck (surprise, surprise!) Then they just took him to a room and tried some tests to have him answer some questions, which he wouldn't because of his SM and the fact that he just met these people! They told me that they felt he just had anxiety and gave me some worksheets on anxiety.  I was so mad and knew they were wrong.  My mother's instinct was so strong on this one!  We ended up getting in touch with an OOP OT who was recommended to us by Dr. E. from the Smart Center.  She worked out of her house, in a quiet, calm environment and specialized in treating kids with SM and SPD.  What a difference!

So here we are again.  My husband wanted me to explore the in network options, so I did that over the past 2 weeks.  We had two places to try.  After going through two days of back and forth calls with the first place and leaving messages to speak to the correct person, I finally spoke with a woman who collected all of Thomas's background info and insurance.  Two days after that, a scheduler calls me back telling me that they have nothing for 4 months and even longer than that if I need something after school, which I do.  Nope, onto the next option.  I called the second in network place where I had to leave a message for the OT department person and am still awaiting a call back a week and a half later.

In the meantime, I also called the two OOP practices and spoke directly with the director at both places. It was such a breath of fresh air talking to these people who I felt already understood my son, because they work with these types of children day in and day out.  I was particularly impressed with the one facility who viewed treatment as a family centered approach and went over everything in detail with me about the evaluation process to weekly goals, etc.  She even knew our former OT.  That was all I needed to know.  We sent over our eval from our previous OT and scheduled our new eval.

I know the decision to pay OOP isn't possible for everyone.  It is barely possible for us, but I feel strongly that working with someone who truly understands Thomas sensory issues and needs is crucial to his success.  We'll find yet another way to cut back.  Maybe Thomas will just have to get used to those haircuts by daddy :)

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