Do/Did You Pay OOP for EI?

[iheartbanjos]

DD2 has her evaluation next week and we need to bring tax documents (I think our 1040) for proof of income. I thought EI was free under age 3. Based on our income, it could be $400/month.

Obviously if she needs the therapy, she'll get it, but I was surprised by this. She just turned 2 last month and has a pretty extensive vocabulary and her comprehension seems good, but she does not string words together. This could be a moot point, but I still feel caught off guard.

Has anyone else had a similar experience?

[mrssandro]

I don't believe EI is ever free. They do it based by income and also if you have insurance.

[Deleted]

It went through our insurance, but we had a $3500 deductible so we had to pay for it all. Luckily we had our HSA account, but it was still a blow to pay so much money for it.

ETA: they did ask if paying the deductible would be an issue for us, and if it was, I know they had some programs/options to help ease it, but we didn't utilize it. 

[dcrunnergirl52]

Sept 24, 2015 10:25:17 GMT -5 mrssandro said:

I don't believe EI is ever free. They do it based by income and also if you have insurance.

This is true in my area (Fairfax, County, Virginia). We pay for each appt. If you're insurance doesn't cover speech therapy, it's set up so that your per appointment cost will never cost more than your specialist copay under your insurance. On top of that, you have a monthly cap, so no matter how many appointments you have per month, you'll never pay more than that.

So, when DD and DS1 were both in speech, we had a monthly cap of $115/mo (based on our HHI, which was in the $150-200K range at the time), and each appt cost $25. 

[Brie]

We pay about $70/month OOP on the sliding scale for income (and we are on the high end of the scale, I think the max payment is like $100 or something).

We had the option for them to bill our insurance and pay the co-pay each time, but we have a $25 co-pay for therapy visits and P gets at least 5-6 sessions a month so the flat fee was cheaper.

[MamaMaui24]

We went through the process before the Affordable Care Act and I believe that is what changed. When we enrolled, it was a sliding scale based on income. Very affordable! We paid $50 per month for unlimited (as therapists saw fit) services. A couple months later the billing changed, it ended up being the same (more?) than private therapy AND then a few months later our ECI company stopped offering ECI services completely.

We also had the option to bill insurance or not. We chose not to so that we would hit the cap with just private therapy, not ECI + private. (Which ended up moot since he has an ASD diagnosis and the cap was lifted.)

My advice would be to check your insurance. An in network therapist could be much cheaper.

[mrssandro]

Luckily we met our deductible this year. So we are milking it like crazy and she is coming three times a week. Each in home session is like $100 dollars. So $300 a week x 4 is going to kill us next year. I am hoping she catches up and needs it only once a month so we can only pay $400 a month.

[mae141]

Insurance was billed and we would have had to pay a copay, but our income was low enough that we did have to pay anything out of pocket.

[iheartbanjos]

Thanks everyone! This shows how little I know about this program. Everyone, including our pedi, was talking about how it is a FREE!!11! service for kids under 3.

I'll update after the evaluation next week.

[jr009j]

I think the costs of EI depend on your state. In my state, it is free regardless of income. No insurance or income information was taken.

[matildasun]

It is free in Maryland, or at least in Baltimore City.

[auntie]

States are free to administer EI/IDEA Part C as they see fit.

In most places it is free of charge. In others there is a sliding scale fee. Sometimes, when a parent has good insurance it's more cost effective to go that route. In some places parents are free to do both, in others families can not "double dip" and use both private insurance and EI for the same kind of service.

[wavepool]

Ours was free. We were asked to volunteer our insurance information so they could try to bill them, but assured us we'd never have to pay, and we never did. Our insurance never sent us anything about it, either. This is obviously not helpful to you, but it is free some places, so maybe that's why the people who told you that thought that??

[Deleted]

MA got rid of requiring payment right before J entered. It used to be a sliding scale based on income. We would have been at the very top of the scale and were expecting to pay several hundred a month.

Now, they just bill insurance and the state covers anything insurance does not pay.

[indifferentstars]

I think the evaluation is free, regardless of income. If you qualify, that's where the variances between how each state administers the program comes into play but I don't think I've ever heard of anyone being charged for the initial evaluation.

My son received EI services in two states and we never paid anything oop but our income is very low by MMM standards, so there's that ;-)

[kershnic]

The evaluation is required to be free in all states. The services are administered differently in different states. Some are free, some have a sliding scale copay, some apparently work other ways. In NY all is free. In NJ there's a sliding scale copay for anyone over 300% of poverty line (which is $73k for a family of 4). We're paying something like $12/visit for speech therapy (our income is low for GBCN but higher than median for area). There's a monthly cap too but at 1/week we'd never hit it. Our reasonably good private insurance would technically cover speech therapy for young children, but it's a $40 specialist copay and we'd have to take her to an office whereas the EI therapist comes to our home. A lot of insurances don't cover speech therapy at all.

[CloudBee]

Yes, it went through insurance AND we had to pay $300 per month on top of that because we capped out of their scale.

We could have gone with a private SLP provider and only paid a $10 co-pay per visit, bringing our cost down to $40 per month. In the end we chose to stay with EI because they routinely evaluated his overall development. As he had hearing concerns we chose to stick with EI.

[Marmee]

Ours was "free" in Denver. Well free OOP, I believe they may have billed insurance (we did provide insurance info) though I never remember seeing direct evidence of that.

We never had any questions regarding income or anything so I know that is not a factor.

We did OOP for ST later (after age 3) because the ST charged $50 which was our co-pay anyway.

[longtimenopost]

We are in TX. They billed our insurance and said our portion was something like $10 a month but we were never billed.

[spk926]

Sept 24, 2015 10:25:17 GMT -5 mrssandro said:

I don't believe EI is ever free. They do it based by income and also if you have insurance.

DD was in speech and we never paid a cent. It's all done through our school district and they never asked for any income or insurance information. If a child qualifies they receives services no matter what. It's funded completely by the state and districts.

[Brie]

Sept 24, 2015 11:07:18 GMT -5 auntie said:

States are free to administer EI/IDEA Part C as they see fit.

In most places it is free of charge. In others there is a sliding scale fee. Sometimes, when a parent has good insurance it's more cost effective to go that route. In some places parents are free to do both, in others families can not "double dip" and use both private insurance and EI for the same kind of service.

Yes, I should also mention that we pay OOP for EI because we also want to use our insurance coverage for private therapy, and they would not be pleased about covering two different OTs and two different PTs and would likely deny one anyway.  His therapists all take very different approaches, and I like having the different POV.

[cep1976]

Another Marylander saying it was/is free for me. Thank God, since she was in it for 2.5 years and had as many as 3 different therapists at a time.

[mrsfarmer]

Sept 24, 2015 11:41:40 GMT -5 spk926 said:

Sept 24, 2015 10:25:17 GMT -5 mrssandro said:

DD was in speech and we never paid a cent. It's all done through our school district and they never asked for any income or insurance information. If a child qualifies they receives services no matter what. It's funded completely by the state and districts.

This was our experience and we are both in MN.  However, they did ask for some insurance information just to offset costs; it was also budget time for them, so I think they needed to balance.

[TrudyCampbell]

I do not (NYC) and my daughter was receiving speech 5x/week and PT 3x/week OT 3x/week. We did have to submit our insurance.

[mlt]

We had to pay $200 a month, which is the cap in my state.

[mrssandro]

I guess Texas just sucks when it comes to EI

[kitty]

We had to pay quite a bit per month, something like $210 or $240 - I can't remember exactly. In my state, it is free if HHI is 40k or less and then goes up from there based on income. It is a flat monthly fee, no matter how many visits you need per month.

It would have been much cheaper to just go through private insurance (since I don't have copays for office visits) but the value of having it in house was worth it to me. We were doing it for motor skills and it was very helpful to have the physical therapist show us how to work with what we had in our home/repurpose objects vs going to the therapy gym where they have all sorts of fancy contraptions that you cannot hope to replicate for practice in between visits. If DD had needed speech therapy or something, I would not have gone through the state program.