For children with complex medical diagnosis, traditional developmental therapy approaches make limited impact on the child’s ability to reach their developmental milestones. Specialized developmental therapies with adequate intensity, on the other hand, can propel these children to their full potential, allowing them best quality of life.
Most children with special needs are entitled to NJ State funded Early Intervention Program. However, the quality and experience of the therapists vary greatly. Many therapists have largely educational experience or may be treating geriatric population most of the time, but wanted to have different clinical experiences. Early Intervention service is either their side job or a stepping stone. These therapists although legitimate for the services they provide, they are, however, not the best for the medically complex and fragile children.
Parents who seek more and better therapies for their children often run into trouble with their medical insurance coverage. While some medical insurance companies deny anything “developmental” all together, the rest of them provide limited developmental therapy coverage. They typically offer between 30-90 visits combined therapies per year. Unfortunately, these provisions often are not sufficient to cover intensive therapies the children may need. As the reimbursement rates vary greatly between medical insurance companies, most outpatient rehabilitation facilities or services that accept medical insurances require their developmental therapists to see as many patients as possible a day to maintain their profit. Such time and cost pressure restricts a therapist’s ability to offer optimal therapy.
Increasingly true, particularly in NJ, many experienced and specialized developmental therapists go out on their own to become private practitioners. In private practices, they are able to offer these children appropriate and adequate therapies. However, medical insurance companies make it difficult for them to become in-network providers. Hence, many do not accept medical insurance although most do provide medical billings for parents to seek reimbursement directly from their own medical insurance companies.
Sammy’s Friends Foundation strives to help parents offset the out-of-pocket therapy costs using a rebate coupon system. Unconventional therapies that we are interested in supporting are: CME (Cuevas MEDEK Exercises), NDT (Neuro-Developmental Treatment), Hippotherapy, TheraSuit, Vital Stim, PROMPT (Prompt for Restructuring Oral Motor Phonemic Targets), RDI (Relationship Development Intervention), and Conductive Education.
Every 3 months, Sammy’s Friends Foundation mails out to each participating therapist or facility an allotted number of Developmental Therapy Coupons. They, in turn, give the coupons to families best fitted and most appropriate according our written guidelines. The families are then instructed to submit their coupon with proof of their therapy payment to Sammy’s Friends Foundation for reimbursement. Currently, we work closely with several Physical, Occupational, and Speech therapists in the New Jersey area. These facilities are approached for their expertise in providing non-conventional developmental therapies and outstanding results to help children reach their potentials.
We have chosen a therapist driven, rebate coupon style momentary assistance program so we can cut down lengthy application process and disperse the fund to needed family quickly. Each coupon is $100, which covers an average of 60-80% out of one individual therapy session’s fee. So far, Sammy’s Friends Foundation has issued more than 40 coupons and helped numerous families.
Parents and healthcare providers can nominate their therapists by writing to or email us. We will contact the therapist or facility and obtain more information. The therapist or facility will then be added onto our participating list and begin to receive therapy coupons..
The family must fit the number ONE criterion and ANY of the subsequent criteria.
- The child has a chronic illness with associated long term disabilities, requiring ongoing therapy. Priorities should be given to those with diagnosis of Infantile Spasm (or childhood epilepsy) and rare genetic disorders.
- The family will use the rebate money for an additional session and this additional session is therapeutically important for the child.
- The family is currently paying completely out of their own pocket because their insurance does not cover their therapy cost (or has reached the annual coverage limit).
- The family is paying out-of-network therapy cost in order to see you.
- The family is traveling a long distance, particularly out of state, or from a different country, in order to see you.
- The family is a single parent family.
The family is struggling financially and has to cut therapy to cover other basic costs such as food and medical expenses.