[BetsyNY]

My son's orthotics were denied by our insurance

:, so now I have to get a diagnosis of CP from someone. How's that for cost-effective--now they'll have to pay for a specialist's visit on top of the orthotics! Wouldn't it just make more sense to pay for the orthotics up front? Grrrrr...

Anyway, who diagnoses this? Physiatrist, neurologist, orthopedist, who?

 

[irangel]

Everyone I know sees a neuro for that type of diagnosis.

 

[BetsyNY]

Good, because we already have one of those.

 

[2boyzmama]

I would think it would be whomever decided he needed orthotics and gave you the prescription for them. Neurologist?

 

[dbsam]

As the pp's mentioned, for our son it was the neurologist.

 

[BetsyNY]

Our PT recommended the orthotics, and the ped wrote the prescription.

I'll call our neurologist tomorrow.

 

[bandgeek]

Our developmental pedi diagnosed DD.

 

[CorbinsMama]

That's ridiculous that they denied a script for orthodics written by your ped!

In our case, our neuro diagnosed the CP, but then the orthopedist prescribed DD's AFOs. Maybe you'll have better luck with your neuro.

 

[KatWrangler]

Quote:

Originally Posted by CorbinsMama That's ridiculous that they denied a script for orthodics written by your ped! In our case, our neuro diagnosed the CP, but then the orthopedist prescribed DD's AFOs. Maybe you'll have better luck with your neuro.

Not unusual. When we had HMO in Southern Cal we were denied Accupuncture for my daughter on a request from the Ped (the request actually was from our NS, but the Ped put in the request). Once the insurance had more information, it was approved.

 

[dbsam]

Quote:

Originally Posted by KatWrangler Not unusual. When we had HMO in Southern Cal we were denied Accupuncture for my daughter on a request from the Ped (the request actually was from our NS, but the Ped put in the request). Once the insurance had more information, it was approved.

We have a PPO not an HMO but he had a similar issue with PT. Our first neuro diagnosed my son with a brain bleed/brain damage from a difficult delivery although he never used the term 'CP'. Our insurance never paid for any of the therapy even though it was requested by the neuros and the ortho. The second neuro used the term 'CP' in her diagnosis and then our insurance covered some of the PT. I wish our insurance covered acupuncture!

 

[CorbinsMama]

Our DD had a Grade III brain bleed at birth, so she was automatically eligible for services through Birth-to-Three. But when we and her PT suspected CP, I marched back to the neuro and told him that if he thought she had CP, I wanted a formal diagnosis and I wanted it filed with our insurance so that she wouldn't ever have any services, therapy, or anything else denied.