I fought the insurance company and won

I have finally got Gavin back into OT and Speech.  Elliott will also be starting OT as well,  only for the first time. We are still waiting on paperwork to go through for Emmett.

This is a pretty big deal because I took on the insurance company and won.

The insurance company said that Elliott was to old to start OT and benefit.  He was 5 years old at the time.  They also said that Emmett is never going to improve.

I appealed the decisions,  presented my arguments and 14 days later,  we won. It is possible to take on the insurance company and win.  I don’t know what the odds are but they are zero if you don’t try.

Gavin and Elliott will begin in Tuesday.  Emmett on the other hand will have to wait a bit longer.  I’m going to have to call again on Monday.

This is a huge win for the Lost and Tired family.  The boys have #Autism and sensory issues.  They need these therapies in order to be more comfortable in their own skin and learn to better navigate their world. It took awhile but the effort was more than worth it.


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About Rob Gorski

Father to 3 with Autism and husband to my best friend. Oh...and creator fo this blog. :-)


  • Dearest_nikky says:

    WAY TO GO!!! 😀 Now loose the anti apple and we can be friends again 😉 

    • lostandtired says:

      @dearest_Nikky You have to understand that what Apple is doing is wrong. 🙂 I don't hate the products, just the company behind them. 🙂 I also hear that we are going to be neighbors

  • AnnMarieHakeHughes says:

    That's just outrageous, that someone is considered too old at 5. First I ever heard of it!  We're lucky, we have a medicaid waiver that covers what insurance won't cover.

  • AutisticSeas says:

    @reality_autism Congrats and it is great that your kids will be able to get the services they need.b

  • julh says:

    I'd like them to meet the 11 yr old with severe autism and cognitive impairment that I started working with 6 months ago, he had never had any kind of early intervention or other services before me. He's developing new language, increasingly seeking out social interaction, almost fully toilet trained (was wetting 7-8 times a day) and his emotional regulation is immeasurably better (no longer having violent tantrums at the drop of a hat). It's never too late. 

    • lostandtired says:

       @julh Thanks for sharing that. I that's what made me so angry. Someone sitting at a desk somewhere makes a judgement as to whether or not my son will ever improve, without ever meeting him and ignoring what all the therapists have said. Very sad..