Friday, September 19, 2008

Insurance Battle update

Well, we are going to have to cancel the estim therapy for now. Our insurance will only cover 20 visits of speech therapy per year and since a speech pathologist does the estim therapy it is coded as speech therapy and counts towards our 20.

Our insurance company did say that the referring doctor could appeal. So we have an appointment with Dr. Brady on Monday to discuss his weight gain and the improvements that I have seen since starting the estim. After we have that visit, she will submit a letter to our insurance appealling their decision to only cover 20 visits.

I am feeling defeated. Before we started the therapy I called to verify coverage. The people that I spoke to never said anything about a maximum number of visits, they only said "yes, you have coverage". I think that it is being dishonest by omission if they do not give you all of the information when you call. They should have told me that when I called those 3 times!! It makes me angry that we started this therapy and are seeing improvements and now we have to stop because we can't pay for it. I feel like I am letting Will down, like I am not providing the best for him because I know that the estim will work if he gets enough of it.

I am still holding out hope that the appeals process will work but I have been told that it is highly unlikely that they will pay. It sucks.


Jacqui said...

Myssie, that is just soooo frustrating for you. To know something would be excellent for your child's growth, development and health - and then to have it denied. I can only pray that you find strength and courage to battle where you need to battle. Is there anyway you can get funding from another source - fundraising, or Special Friends. Don't give up, sounds like it was being so beneficial for Will.

Blogversary said...

That is hard. Definitely good to talk to your Dr. And, don't give up.

Liddy said...

Myssie, that's pretty crappy that they didn't mention the 20 visit thing. I hope that the appeal works out for you guys and you get started again soon!

Terri H-E said...

That is just ridiculous. Fight, fight, fight. Insurance is just business to way to many people involved.

When you can't fight any longer or when the fight is done, ask for help. Help will arrive and Will will get the therapy he needs. This is know.

Jessica mommy to Alex/ RTS said...

We were told not to bother fighting for Alex's peptamin jr too. SInce we have the same insureance, Im not surprised by your post.Dont feel defeated, its not over.