Monday, January 7, 2008

On Insurance Companies, being stuck in the house etc

Fair warning - I need to vent some frustrations, you don't have to read about them.
I finally called our insurance company today to try and figure out why they aren't paying for Alexa's speech therapy. Now you have to understand that I have been trying to get her speech, physical and occupational therapy since April of last year. At that time there were no "in network" providers accepting new pediatric patients in this area. So I asked for a "gap exception" (I hope that is the right word), I already had one for another doctor I saw for the same reason. After waiting on hold for 30 minutes and being hung up on, they told me that I couldn't have a gap exception because I lived in Oregon. No amount of logic swayed them from this explanation. Finally I found someone accepting new patients and they called to check my benefits. The company told them that I had already paid my out of network deductible and would be covered for 70% of the cost of 20 visits. So we went for a few visits, and they billed us for them because we hadn't paid the out of network deductible (of 1500$). So we quit going, paid the bill, and the therapy providers applied for in network status. In August they became an in network provider and so we started speech therapy. We applied for pre approval for physical and occupational therapy. Then we started getting letters saying they would not pay our claims because they did not cover speech therapy for Alexa's diagnosis. We carefully read our policy and it does in fact cover speech therapy for "congenital anomalies" which presumably includes Alexa's diagnosis of "developmental delay", but they now want the speech therapist to send them her clinical notes with a diagnosis that fits that criterion. Unfortunately, they claim never to have received either of the two requests for pre-approval of occupational and physical therapy, and I expect them to reject it anyway since they only cover PT and OT for rehabilitative therapy expected to produce improvement within two months. This is so maddening to me. How can they not cover a child for a condition she was born with?? Now I have to contact Shriners and March of Dimes and any other random group of people I can think of to help, and meanwhile we have to pay out of our own pocket. We have no control over our insurance coverage since it is through David's job.

Meanwhile, Alexa is into everything today. She pulled the garbage bag out of the can and all of the new garbage bags out of their box and all over the floor. She chewed holes in her only white t-shirt. She keeps trying to pull her diaper and pants down, but will not go potty in the potty. She pulls my books and magazines off the shelves. While I tried to organize my spices today she kept stacking them, dropping them on the computer and running off with them. She does most of this while I am on the phone with the insurance company, so I have to try and carry her around without hanging up the phone. I am impatient with her and frustrated that I can't seem to get anything done. On the other hand, she is learning so many neat new things lately. She is climbing really well, signing new words and using her signs more accurately. I am really proud of her.

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