Called the insurance company today

[Lady Mayapple]

What used to be our "awesome" insurance has become instantly not-so-awesome. When I took DS1 to his regular ped for the referral, a got a statement from the insurance company saying that visit was not covered. When I asked why, they said it was because of the diagnostic code. When I asked what that code was, they said "developmental delay". Fast forward to today. I call the insurance company again to try and find out what is going to be covered and what isn't. For example, if my son needed speech therapy, how much is covered? I was told 15 visits are 100% covered depending on the diagnosis

So this is what insurance companies do? They just pull a decision out of their rear end? I feel like I'm playing Russian roulette with these people. They might cover it, they might not, it all depends on whose desk it lands on and what kind of day they're having. WTH?! My state tried to pass a bill that would forbid insurance companies from refusing to cover developmental disabilities and related services, but the bill died before it ever made it to the ballot.

Either way, my son needs to be evaluated. Now that I have all of the paperwork done, I am sending it in and scheduling the appointment anyway.

This is so frustrating. I just want my son to get help!

[QueenOfTheMeadow]

Talk to your doctors office. Often they are willing to change the diagnostic code to something close that the insurance will cover. We've had that happen and time or two.

[JollyGG]

Originally Posted by QueenOfTheMeadow

Talk to your doctors office. Often they are willing to change the diagnostic code to something close that the insurance will cover. We've had that happen and time or two.

Agreed. Sometimes they have codes that are more or less specific and a different code may go through.

I knew someone who worked in billing at a hospital (he hated the job) he was telling me one day that he had different codes for "a cough", "a dry cough", "a cough with sputum".......

He said that sometimes the more specific code would get it covered sometimes the vauger one. Plus he pointed out that with so many billing codes it is possible to miscode something resulting in it not being covered. Calling the billing department and explaining the issue often got things covered.

[workjw]

Originally Posted by QueenOfTheMeadow

Talk to your doctors office. Often they are willing to change the diagnostic code to something close that the insurance will cover. We've had that happen and time or two.

We've had to do this a few times as well. Good luck! Insurance can be soooo frustrating!

[KatWrangler]

Agreed. Call the Ped's office and have them change the code and resubmit it.

As far as the number of visits go for therapy. They can extend it. We have that with my husband's therapy (he has Bipolar II) and with Gabrielle's Physical Therapy. They only approve so many visits at a time.

Now this isn't always the case. But it's the case for us right now.

[KatWrangler]

Oh and

[Kristine233]

Big hugs, insurance companies SUCK! I agree with talking to the Dr and having them recode it. We've done that in the past too. If it doesn't work and the bills are pretty high then I suggest checking into your tate's Katie Becket insurance, from my experience it covers pretty much everything (at least in MN it does).