a vent - My insurance company thinks I am unstable

[dbsam]

Just a vent, I’m sure many of you have dealt with insurance company frustrations.

My insurance company thinks I am unstable. I started out calm, became frustrated, then started crying – ugh!

To summarize my conversations with BCBS and Compsych today…
They will not cover any Neuropsych testing for my daughter but will cover the initial assessment for her Neuropsych eval; which is a small fraction of the total cost (if the doctor is in network but they have no in network doctors at University of Chicago or Children’s Memorial so they cover nothing).
They will not cover my daughter’s testing at a mood disorder clinic but will possibly pay for follow-up care (I guess that is good – if we can find an in network doctor.)
They do not cover my son’s physical therapy. (Of course I've known this, I just had to bring it up to them while I was ranting.)

The insurance rep kept saying…’your plan has a lot of limitations’ and ‘your group has very little coverage’. (Strangely, our plan is considered a ‘Cadillac plan’.)
I am glad to have insurance since so many people have none; but am frustrated at the limitations on our coverage. To ease my frustration I keep reminding myself how expensive the NICU stays were and how much the insurance paid - there is some value in our coverage.
When I worked I had great coverage but never needed/used it.

[AuntLavender]

You only had great coverage bacuse you didn't have to try to use it!

Just this week I told someone at an insurance company they were "crazy!".

Back when we had Aetna they sent us one letter worded "60 consecutive visits of speech therapy" and one that said "60 visits of speech therapy.". Consecutive meant he had 60 days in a row not 60 visits over the course of a year. They also sent a letter saying my son had reached his "lifetime limit" on speech therapy. We can never have aetna again. Just like that they decided he is cut off from therapy.

Last year we got our insurer to buy a speech generating device. It cost almost $7K!! Yet they won't pay for therapy at their rate of $15/session of which you only get 60. And those are combined with occupational and physical therapy.

My son only has 4 fingers and 2 thumbs.

I read your vent and understand where you are coming from. I always cry when I have to call my insurer.

Sincerely,
Debra, homeschooling mom of 4 ages 13, 12, 10, and 6 1/2

[rainbringer]

I would cry too. We have insurance but paid about a thousand dollars a month last year for dd's therapies.

[ReadingMama]

I believe if there are no specialists in network, you can write a letter to request that an outside specialist be considered as in network. It's a battle, but worth a shot. Or is there a teaching hospital with a pediatric developmental/psych clinic that could do the testing on a sliding fee scale? Do you think you could find a doctor who would take payments?

For some reason, my son's neuropsych testing was covered. We'd been told by the doctor's office not to expect full coverage. I think it was because we went to see a developmental pediatrician and it was billed through medical rather than mental health. So much for health care parity, huh?

I hope you find a solution. It's a day-ruiner having to deal with insurance companies.

Debra, do you have a Scottish Rite clinic anywhere nearby? Our Scottish Rite Language Clinic does free testing for speech delays, trouble with reading, and swallowing issues. They also offer free therapies, but there's a waiting list to join the program. Perhaps that might be an option for you.

[KatWrangler]

Oh how I feel your pain and frustration. I think most of us here can relate in one way or another.

[Kristine233]

I'm a big advocate of checking out your state's Katie Becket insurance. Its for kids with special needs and may be under a different name depending on the state. Its based on income, but the fees are very reasonable if you make too much. It was a godsend when we had no insurance and the insurance available didn't cover anything that was actually useful.

[yarngoddess]

I wish there was an Easier way to handle all of this And all of you that struggle and fight with your insurance don't give up! Besides that- WHO CARES if they think we are nuts! THEY aren't the ones that are dealing with kids that need services and help!

[dbsam]

I originally started this thread in Jan but unfortunately it is still applicable today.

I just got off the phone w/the ins company. Last night my husband went to the eye doctor with a concern. He went back this morning for more tests. He has a tumor on his eye and although our eye doctor can remove it he is recommending my husband see a specialist in Chicago who can also do radiation if needed. Our doctor is calling the specialist this morning and wants to get my husband in quickly. So, I called the insurance company because effective this month, we need to have procedures and tests approved by a third party case management company - ugh!! Our PPO is looking more and more like an HMO. We are not stupid people, and our doctors have actually gone to medical school, why do we need a third party to decide our doctor is treating appropriately??? I'm sure they will approve the surgery; I'm just irritated that we need to have it reviewed at all.

BTW, the ins rep said just about every person who calls goes into an emotional rant about the new policy.

[RiverTam]

Ask them to send you a copy of your policy. Sit down and read it to see if they're accurate, or ask a lawyer to review it for you.

I had an adult client with eosinophilic esophagitis. The insurance company told him that his policy did not cover the formula which he needed to eat. When I reviewed his policy, it was clear that the formula was covered 100%.

Some claims reps don't understand what they're reading.

[dbsam]

Originally Posted by RiverTam

Ask them to send you a copy of your policy. Sit down and read it to see if they're accurate, or ask a lawyer to review it for you.

I had an adult client with eosinophilic esophagitis. The insurance company told him that his policy did not cover the formula which he needed to eat. When I reviewed his policy, it was clear that the formula was covered 100%.

Some claims reps don't understand what they're reading.

You're correct. Since my original post I read the policy and found they would cover some of my son's PT (partial coverage of each visit up to $5k) so I am going to fight for that going forward. And although they didn't cover my daughter's testing, based upon what I am reading and the fact that the neurologist and psychologist say her 'issues' are a result of the epilepsy, her psychotherapy (if needed) might be partially covered.

While I was posting this the 3rd party mgmt care company took me off hold. My husband's biopsy is scheduled, but we are supposed to call them while we are in the office before the biopsy to get approval - it's crazy.