can an Occupational Therapist (OT) refuse to treat your child due to possible behavior issues?

Discussion in 'General Parenting' started by shelleyils, Aug 27, 2014.

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  1. shelleyils

    shelleyils Member

    I haven't posted her in a long time. My 12 year old non verbal autisic son is doing much better in a new school. He gets in home st and she suggested that taking him to an Occupational Therapist (OT) gym would really help with his sensory issues. There is only one place near us that takes our insurance. He had an evaluation and they agreed that he could benefit from it. Here is our problem. My son is on medications and does have horrible meltdowns from time to time. We don't know what causes them and they can come out of the blue. He will bite you, bite himself, or bang his head on the floor or wall. We cannot predict when and where he will have one. Anyhow, in order for him to get help at the Occupational Therapist (OT) place, they wanted us to have his psychiatric dr change his medications and write a letter guaranting that he won't be a danger to himself or others. We took him to the psychiatric dr. yesterday and she said that was just a nice way of them telling us they don't want to treat him. She said she cannot guarantee the behavior of anyone. The only medication change she made was she upped his adhd medication to one tablet twice a day instead of half and tablet twice a day. But there is no telling how his behavior will be from day to day. He might have a great day one day, then a bad one the next. What should we do?
     
  2. Wiped Out

    Wiped Out Well-Known Member Staff Member

    Sounds like a really tough situation. I believe they do have the right to refuse (not positive), however, if he has an iep at school, he could qualify for Occupational Therapist (OT) there and they can't refuse (I believe).

    I wish I had some ideas. I'm surprised they refused when that is something that could help. ((((hugs))))
     
  3. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    Like WO, I do believe they have the right to refuse. They can back up their decision by saying that your son poses a threat to their staff or other patients/participants in the program. Is there anyway you can find out if anyone in the area can do the Occupational Therapist (OT) in your home?
     
  4. shelleyils

    shelleyils Member

    I think he does get some Occupational Therapist (OT) at school, but we were looking for some extra help. The reason we don't just have an Occupational Therapist (OT) come to our house is becasue the Occupational Therapist (OT) place has more equipment like a swing that he loves. I think they are scared he's going to have a meltdown if they make him do something he doesn't want to do. I can't guarantee he won't. We will see how he does with full tablet of the adhd medication.
     
  5. susiestar

    susiestar Roll With It

    Unfortunately the Occupational Therapist (OT) is a private business and can refuse service if they want to. I don't know if going in without him to talk abuot this would help or not. If they won't see him, you can ask your insurance to approve another Occupational Therapist (OT) in your area. Insurance companies generally have a provision to approve vendors if you cannot find one in your area. I think it may be called an exception, but I am not sure. It takes some patience and time to get all the paperwork done and the process can be frustrating.

    I used to have to do this for a few things, esp for Occupational Therapist (OT). First you have to go ahead and find an Occupational Therapist (OT) who is willing to treat your child. Then you get the Occupational Therapist (OT) to agree to take your ins if the ins co will approve them. That can be the really hard part because part of being an ins approved provider is accepting what the ins co will pay as the fee for the service. This can be substantially lower than what they would charge if you just paid for their services out of your own pocket. Once the Occupational Therapist (OT) is willing to accept the ins co payments, there is paperwork. Calling the cust svc line should get you to someone who can help you with htis, though you may need a supervisor. If you cannot get someone to help with this, ask your employer's HR dept to help with this. If your employer is of a fairly large size, the HR dept has probably had to do this before. If they have not, they still have more clout than you do and can be helpful. Once you have the process figured out, you have to get the Occupational Therapist (OT) and the doctor ordering the Occupational Therapist (OT) services to do whatever paperwork is needed and then you have to wait to hear what the ins co says.

    The ins co wait is the hardest part for me. I can remember thinking that they were just waiting to see if I would go away before they ahd to approve it and pay for it. If the ins co was doing that, they didn't know me. For the first week or two, I called once a week to check on things. Then I called more often and I documented the name of each person I spoke to on every call. After about 3 weeks, I start calling every day, asking for the status. It is VERY true that the squeaky wheel gets answers and gets stuff done, at least that is my opinion.
     
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