V
Vixtres
Guest
What is the name of your state? Louisiana
Hi,
This story is such a nightmare..........bless anyone who reads it.
Subject:
My son was in speech therapy and our insurance company quit paying for it during the middle of his treatment.
Long version:
I brought my son to our pediatrician to get a paper trail started for speech treatment. The Dr. referred us to our local hospital for speech therapy due to a developmental disorder and severe speech delay.
The Dr.'s office called our ins. co., the phone number on the card, to check and see if ST was covered. They said yes. The Dr. also referred us to a neurologist to evaluate my son.
When I get home that afternoon, I called my insurance co. to make sure that the visit to the neurologist was covered, they said no. I also asked about speech therapy, the manager that I got on the phone said "yes, it is covered. If you have any trouble, let me know." I got his name and his direct number at the office.
We go to the neurologist anyway for another eval. The Dr. there recommended Occupational Therapy along with Speech at the same Hospital.
We finally get our appt. for a speech and OT eval at the Hospital. The Speech Dept. couldn't get anyone on the phone at our ins. co. so I called the direct number to the manager I'd spoken with earlier about coverage. He spoke to the person in the Speech Dept and approved coverage. He told her it was covered 90%, no ceiling.
We started Speech and OT, everything was going beautifully for my son. We went for about 4 mos. before any problemes started arrising.
After Jan. I noticed that the ins. co. wasn't paying anything according to my EOB's. I called that particular manager, David, and asked him about it. He said not to worry, he'd take care of it.
Months later, nothing was ever done about it. I called him and he told me the same thing, he'd take care of it. His assistants knew about the problem and said he'd written a memo telling the claims supervisor to put them through.
Well, come to find out, speech was never supposed to have been covered if my child had never had a brain injury. And this man, David, never had authorization to approve our coverage. The company he works for is just an administration co. that my husband's employer hired to do the administrative portion of ins. claims, my husband's company is self pay, or self insured.
This manager, David, denies ever approving the coverage and denies talking to me about it before we ever started the therapy sessions. So, basically, it's my word against his.
The administrative company denies ever paying for the speech therapy. But I have all the copies of the bills that the hospital sent to our ins. co. And they paid upwards of $8000 or so on that speech acct. The administrative company claims that the hospital "changed codes" to get them to pay for services.
Is there anything I can do right now? I owe a lot of money and my husband's co. said that I should accept what they did pay as a gift since they were never supposed to cover speech therapy in the first place. But they refuse to pay the rest of the claim.
I am beyond livid at this point. Is there any recourse for me?
Thank you so much for any responses.
Vicki
Hi,
This story is such a nightmare..........bless anyone who reads it.
Subject:
My son was in speech therapy and our insurance company quit paying for it during the middle of his treatment.
Long version:
I brought my son to our pediatrician to get a paper trail started for speech treatment. The Dr. referred us to our local hospital for speech therapy due to a developmental disorder and severe speech delay.
The Dr.'s office called our ins. co., the phone number on the card, to check and see if ST was covered. They said yes. The Dr. also referred us to a neurologist to evaluate my son.
When I get home that afternoon, I called my insurance co. to make sure that the visit to the neurologist was covered, they said no. I also asked about speech therapy, the manager that I got on the phone said "yes, it is covered. If you have any trouble, let me know." I got his name and his direct number at the office.
We go to the neurologist anyway for another eval. The Dr. there recommended Occupational Therapy along with Speech at the same Hospital.
We finally get our appt. for a speech and OT eval at the Hospital. The Speech Dept. couldn't get anyone on the phone at our ins. co. so I called the direct number to the manager I'd spoken with earlier about coverage. He spoke to the person in the Speech Dept and approved coverage. He told her it was covered 90%, no ceiling.
We started Speech and OT, everything was going beautifully for my son. We went for about 4 mos. before any problemes started arrising.
After Jan. I noticed that the ins. co. wasn't paying anything according to my EOB's. I called that particular manager, David, and asked him about it. He said not to worry, he'd take care of it.
Months later, nothing was ever done about it. I called him and he told me the same thing, he'd take care of it. His assistants knew about the problem and said he'd written a memo telling the claims supervisor to put them through.
Well, come to find out, speech was never supposed to have been covered if my child had never had a brain injury. And this man, David, never had authorization to approve our coverage. The company he works for is just an administration co. that my husband's employer hired to do the administrative portion of ins. claims, my husband's company is self pay, or self insured.
This manager, David, denies ever approving the coverage and denies talking to me about it before we ever started the therapy sessions. So, basically, it's my word against his.
The administrative company denies ever paying for the speech therapy. But I have all the copies of the bills that the hospital sent to our ins. co. And they paid upwards of $8000 or so on that speech acct. The administrative company claims that the hospital "changed codes" to get them to pay for services.
Is there anything I can do right now? I owe a lot of money and my husband's co. said that I should accept what they did pay as a gift since they were never supposed to cover speech therapy in the first place. But they refuse to pay the rest of the claim.
I am beyond livid at this point. Is there any recourse for me?
Thank you so much for any responses.
Vicki
