Oh..it gets BETTER!!!!!
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| Mon, 07-23-2007 - 9:29pm |
Ok, I have an even bigger, better, scarier insuranc b!tch to post. Are we all sitting neatly, carefully, criss cross apple sauce...good!
BOO!!!!!!
Hee hee, ok I'll be serious. Here's how it started...picture it, boring Westminster, MD, 2005, a beautiful lil' boy with great sweetness, yet awful articulatory , expressive and receptive language skills finally prods his parents enough to find him speech therapy. It's all good, Insurance even promise to cover said speech appts for 1st 12 sessions, ...then they even approve a second set of 12 sessions for 2006. We are thrilled. Our said blonde, blue eyed, (although klingon speaking) angel gets EI twice a months and private speech a few times a months).
We move, get better IEP, blonde child gets 60 mins a week from preschool services, no more private speech all is well. Flash forward to TODAY!!!!
Insurance have decided (2 years after the fact) that first 24 sessions shouldn't have been covered, have removed said cash from speech therapist office and now same office is up my @ss looking for $1300. Holy Mother of GOD!!!!!!!
Btw: We are still fighting present INS for dev ped benefits and not sure we'll get them, and now we need to fight old INS to boot. We spent the day calling the speech office, Aetna office....you name it. All boils down to...We get FECKED!! The ins approved and paid benefits for a year, finally asked for session notes; session notes said non-restorative in nature, (as was sent before that), and ins finally read them and reneged on benefits. ie: I have to find $1300 in 6 weeks, oh as well as $1450 to cover clinical pdoc for Cian, (blonde kid).
Needless to say dh is going to work his @ss off doing night school this Fall/Winter and I'll never see him. Isn't life grand...
btw: Michael Moore is RIGHT!!!!!!!!!!!!!
Dee (aka: very mad Momma)
Edited 7/23/2007 9:58 pm ET by roanmom
Edited 7/23/2007 10:00 pm ET by roanmom

WOW! Would this be worthy enough to put a call into a lawyer? I have never in my life heard of a insurance company pulling something like that!!!
Thats terrible!
Ah here!
visit my blog at www.onesickmother.com
hEY ALL, I would go as far as to call your local TV station. I bet st least on of them have a Shame on You reporter who would just love to do a report on this. .. Definitely go with a lawyer and Get the media involved. It could turn out to be a major investigation here. Someone should get screwed and it isn't you..
Rinba
Yea really the more I think of this the more it burns me up. I mean tuff poop if they made a mistake. Thats not your problem. And I can't believe they pulled back the money from the speech place????!!!!
I mean too bad so sad you know?
Dee,
That is ridiculous!!! I would try to fight this on your own first though, often insurance companies think we'll just say okay and pay the bill. You would probably spend as much on the lawyer as the bill will be. Of course, the insurance companies count on that. You also might want to get copies of the notes from the SLP. If her notes are shoddy and that is part of the reason for the denial, then she has to take some responsibility as well. I don't know that she can technically go after you for the money. (the hospital I work for doesn't, my husband has a private practice and might, depending on the circumstances).
This being a mom of a special needs child is a fullllllll time job + some. Not just the parenting, but navigating the educational and medical systems as well. It's amazing.
Best wishes,
Kara
delete
Edited 2/19/2008 1:39 pm ET by littleroses
I like Rina's idea about that news segment thingy, although I don't ever remember seeing one which involved a health insurance company.
visit my blog at www.onesickmother.com
I agree with the others about getting media publicity to your case. Many of the TV and radio stations around here (Maryland) have segments devoted to getting situations like yours solved. You might mention to Aetna that you're going to sic the investigative reporters from the various TV & radio stations on 'em to see whether they can really renege after approving services and then stick you with the bill. If that doesn't get Aetna's attention, then fill out the online forms for places like WTOP, Channel 7's "Seven on your Side," etc.
It stinks that you get saddled with all the work to solve the problem, but I hope it works out in your favor at least.