I'm havin a huge run around with TriWest right now and I need input. My daughter was diagnosed about a year ago and a year before that it was suspected but they wanted to hold off on the diagnosis and see if some speech therapy would work to rule out it just being a communication issue. Over the past year she was receiving various therapies (speech/ ABA mainly) near Camp Lejeune. In either June or July she was up for reassessment to continue ABA services. We were moving to out here in may and I was told the reassessment would need to be done in Pendleton for TriWest to consider it for therapy out here. I had qualms with that bc it meant more time she went without therapy but I accepted it. We left Lejeune May 25.
Fast forward and were here. Go to PCM for referral and Tricare sends us to a doc in town. First they denied I saying the didn't see a need for her to have ABA but that was fixed. So we do the assessment and my doc put in a request for further testing. Tricare approves only 1 hour an appeal will take 60 days. The doc is now going to bill me a generous amount of $125 (normally he bills $200 for tricare and $300 for regular pts) for the time he has spent writing the eval. This doesn't include the appointment to the assessment time or the time to go over the eval. Has anyone else had a similiar issue?
My recommendation is to work with your EFMP case manager to assist with getting this approved. Also there is the San Diego Regional Center that can assist with the evaluation. They are a state run program, and they did the official dx for my daughter which was accepted for services.
Tricare Echo should be what you can use for autism services.
I am sorry you are dealing with this, it can be very frustrating.
San Diego Regional Center is amazing! I have 20 month old son, who has autism. We just moved here in June, and they will get services started with a vendor who takes tricare, until you can get it approved through Tri-West.
Yeah we found out that she wasnt even enrolled in ECHO out her even though I was told that it was "all taken care of." I was also told y our EFMP case manager that they are a resource and referral program only and can't advocate for us. This is different than Lejeune so I was under the impression that they really couldn't help us but I'll chat with them again.
My child is not autistic but she is behind one year in her speech. I went to San Diego Regional Center in San Marcos and they are great Help!! They also help you cover what tricare doesn't cover if your child need more the therapy. This coming school year they are going to start getting her ready to go into school for the next coming school year (2013-2014). I guess tricare only pays for speech therapy til the age of 3. They are going to cover everything for this coming year, Since her Birthday is aug 31th (she will be 3).
Oh see they don't have room for her at school. She is supposed to go full time and there is only one school in the Oceanside district that does that. Aside from that I was told that they will not be starting to schedule IEP meetings until at least mid september when everyone has started and is settled in. Her current IEP wot be excleted because it's out of state and the 30 mark has passed since we got here June 18th. :/
I wanted to out her into private preschool/daycare but I wasn't prepared for the sticker shock here. We paid $155/week in Lejeune. Here its $200-235/week.
You need to call the oceanside special ed department and let them know your new to the area and need to find out how to continue you child's early special education services. If she had and ifsp then they have 30 to do her assessments and place her. Every school campus has a special ed classroom and most have 1-2 early special ed classes. If I were you I would get online and look up F.A.P.E and read everything there is about pre-school. If you have problems with the school district contact the efmp office and ask if you can sorely with the efmp lawyer. Another place you should call is regional center and see what service's she can get through them. If you need some direction let me know. We have been involved with special ed for over 8 years and have had to battle with them on almost everything.
I called the head of Oceanside school district and was told they will not schedule an IEP meeting until mid September. She has an IEP from NC but not one for here yet.
Thank you though I'm sure I'll have more questions. Basically now what's happening is it turned out he is forcing us to pay for the time he spent writing the assessment. He was supposed to just talk with is the first appointment . He went ahead and did some testing. He should have put in a request for an hour of testing time and then another hour to go over everything. He is in the wrong and we are ending up screwed because of it. I'm filing a formal complaint with TriWest against him. I think they were trying to get paid for stuff they aren't supposed to get paid for and then an extra 4 hours of idk what. But he said he spent 3 hours writing he report that TriWest doesn't cover and doctors usually never charge for and we sat an hour in his office plus one hour for our appointment Sat. That's 4 hours. Not the 8 the requested.
If your daughter has an iep then they have to implement that iep. They can't just push you off till September and Randy knows that so if you didn't talk to Randy then you did not talk to the head of ess, and your getting the wrong info.
"12. Can a family get reimbursed for tuition if their child attends a private preschool? Children with disabilities, from ages 3 to 5, may receive preschool services in a private program as part of their IEP. Some school districts may try to limit reimbursement for placement in private preschools where there is no public preschool, but this is not allowed if the IEP states that the least restrictive environment is a preschool program with the childs typically developing peers and there is no public preschool program.25"
Does that mean she can only get private preschool with reimbursement if there is no public preschool available? Or does it mean that she can get private preschool with limited reimbursement regardless of if there is an existing public preschool?
This might be something I push for if I can. She did amazing in full time care over the last year. She went from not talking to being almost on par with her age group. It was a complete shock to everyone. The schools here don have full day preschool public school though only half day. The one full time head start program out in town if full and won't take her until she has the updated IEP from here anyways. We paid $155/week in NC for her to go to school but I wasn't prepared for it to jump $80/ week and we just can't afford that.
I think your going to fo.d that most school districts throughout the US are 1/2-3/4 day classes, and that your experience is a rare one. I can tell you from first hand experience that oceanside school district will likely say no. They do to almost everything above and beyond what the "normal" special ed students receive. If your open to the idea I would love to talk to you, share with you what our situation is and how we were able to get OUSD to provide the services my son needs. I will send you my # in a private message.
I think your going to fo.d that most school districts throughout the US are 1/2-3/4 day
I figure but it's worth a shot. She craves that schedule and structure. We tried to so part time preschool before I put her in full time and it was a disaster. It made home life even worse. She cries all the time because she wants to go to school and I feel horrible.
I can completely understand. My now 8yr old went from 52 hours a week with regional center to 20 hours a week at the school. He was so use to a full schedule that he didn't know what to do after school. in the long run it was the best because we were able to piggy back with aba @ home and he made huge improvements. This last year he was in second grade and they worked really hard with him to potty train, with no luck. The Monday after esy ended I talked with him, put him in "big boy underware" and he has been potty trained since.
My son who is now 7 was diagnosed at age 2. We went through San Diego Regional Center. They were amazing. He received 10 hours a week of behavioral therapy. 2 hours a week of speech therapy and 1 hour a week of occupational therapy. At the age of 3 he was transitioned into the chula Vista School District Special Ed Program. He was provided speech therapy, physical therapy and occupational therapy 4 days a week for 3 hours a day. They also provided swim lessons, potty training assistance and my mother and I were able to volunteer in the classroom one day a week. EFMP is a great way to start. They are very helpful. They will even attend IEP meeting with you.
I agree with some of the above postings and recommend that you contact the San Diego Regional Center. Their North County location is in San Marcos. The Service Coordinators (your assigned case worker) sole purpose is to advocate for you and your child and to help you get the services you need to help your child be as independent as possible. They are a great resource and have lots of vendors throughout the community.