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Five Steps to Getting an iPad Covered by Insurance

This is a simplified version of the steps one parent took in getting an iPad covered by private insurance:

1. 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%)

2. Phone your insurance company and ask, “Please assign me to a case manager that is experienced with special needs children.”

3. 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 it is being introduced by Speech Therapists and OT’s in public schools for special needs kids, as well as in private therapy. 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 incur. They may tell you “NO” at this point. If they do, ask them to email or fax you a letter of denial immediately.

4. 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.

5. 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 Claim for Reimbursement:

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

For more information about this topic: 5 Tips for Getting iPad Covered by Insurance


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