How Insurance Regulations Impact Your Child’s Services & What You Can Do About It

By Jeffrey Marler on March 4, 2014 in Blog with 1 Comment

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As a parent or a care-taker of a loved one, have you ever found yourself in a position to have to ask tough, and sometimes painful questions about their educational needs?

(1)    When you have a family member who is in need of help, how long do you want to wait?

(2)    Once the needs have been recognized by a professional, how eager are you to start your child’s therapy as quickly as possible?

(3)    If the process of addressing it were in place, how upset would you be if therapy was discontinued for a couple of weeks every quarter, while administers reassessed the validity of your family member’s case?

The last couple of years I was in clinical research, I frequently heard these types of frustrating experiences from the parents of my clients. Many of the negative impacts caused by “differences in learning,” or what some people call learning disabilities, can

be significantly diminished with early identification and immediately action based on focused and consistent treatment plans. These treatment plans should be designed specifically for the client, as well as supporting the dynamics of the client’s family. This is what we do at ASPIRE Innovative Language Interventions (ASPIRE Interventions).

This style of individualized testing and treatment is exactly what nationally prescribed health care does not support and cannot provide. The problems outlined in the first three questions are exactly what happens to families when they try to fit themselves into treatments-for-the-masses.

These are a few of the recent stories I’ve experienced:

  • I worked with a young boy who originally was diagnosed with a pragmatic language disorder (PLI) diagnosis. His parents were concerned about poor social skills and his mother didn’t understand why he couldn’t “get his words out in a way I can understand!” Three-hours of testing and numerous hours reviewing video resulted in my diagnosis of a motor-tic disorder (confirmed by a developmental psychiatrist), which treatment for is VERY DIFFERENT than what you would design for a child with PLI. Medicaid will reimburse a speech-language pathologist to spend about 90 minutes testing AND report writing when the suspicion is speech, which would have been short in this situation. Medicaid is a similar health care model to the new Affordable Care Act, and would have miserably failed my client and his family.
  • A friend and speech-language pathology colleague of mine told me about a little girl on her case load that needed considerable help with language learning. She responds well to her therapy, but because of attention issues requires very consistent teaching and frequent sessions. My colleague has to discontinue the child’s therapy for two to three weeks every quarter while the child’s family’s healthcare provider reassess the case and decide whether care is to be continued. This process does not well serve this child or her family.

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These are just two of the reasons we at ASPIRE Interventions have built our business upon a direct-service model. We do not design our clinical practice around the suggestions of insurance companies or the Affordable Care Act, but upon our clinical knowledge and expertise. We provide individually designed treatments exceptionally well. We see our clients and families succeed and prosper in their new skills. And then we revel in our clients not needing our services any longer. At ASPIRE Interventions, we help children to learn through building on their strengths and we show parents how to be their children’s best teachers. If you share our vision for how children and their families prosper beyond what they had hoped possible, then join us! It
is NEVER too late to learn to love learning.

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Jeffrey Marler

About Jeffrey Marler

Jeffrey Marler has written 44 posts in this blog.

Speech Pathologist, Communicator, Listener, Researcher, Therapist, | Southlake, Texas Dr. Marler is an internationally recognized clinical researcher. At ASPIRE – Innovative Language Interventions, PLLC, you receive care and treatment from a professional with 28 years of experience with learning disabilities and 15+ years as a speech-language pathologist. Dr. Marler has a PhD in Speech and Hearing Science with an emphasis in auditory-based learning disabilities. Connect on Google+

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