I'm very frustrated right now & needing some guidance. Basically, my son w/SN (ADHD/LD/SPD) is requiring vision therapy. The cost is very high and not something we can afford. Because we adopted our son from the state, we have state insurance for him. When I asked the eye care place if insurance covers it, they said that typically no & that we are to pay & can hash it out with the ins company. So I called the ins co & they said (politely) that they can't talk with us, that it's the responsibility of the eye care place and that's the protocol. So I called the eye care place back & told them & she said that they were *not* going to call.
I got very frustrated because we're in between a rock & a hard place. I told her we couldn't afford it & that there's a good chance that the vision therapy will be covered due to his SN. She was firm that she would not call, but ins said that it is the duty of the eye care place to call to establish whether it's a covered charge & if the eye care place doesn't, then they don't get paid. I feel like this is a sneaky way that the eye care place ensures that they get their money (from us!).
So I had my husband call, thinking that sometimes a man gets listened to better than a woman. She gave him the same song & dance. But the kicker is, the therapist (who works contractually through this eye care place) left a mssg stating that the reason they don't call insurance is because they only get paid $15 on an $80 bill (BTW, it's $80 per session & my son will need at least 8 session plus there's a program we have to buy, etc, etc) --so it's spendy. I feel like the office lied to me, saying it wasn't covered.
So my questions to you are, is this legal? Does anyone know of a low-cost or DIY program for vision therapy? His diagnosis is "Convergency Insufficiency" which basically means he has difficulty tracking & sustaining his eye/brain to track. I would appreciate any advice because I'm just sitting here crying because I'm so frustrated & feel like I can't get straight answers or having the person do a simple thing as call the insurance company. I can't help it if the ins company only pays them $15