Thursday, April 22, 2010

Insurance sucks and blows at the same time.

So, every three months for the last two years, I've had to call my insurance company up and harrass them into approving another 12 visits of OT for Frank. No, the SPD has not been cured. Yes, he still needs OT. Well, a few weeks ago I got a letter from the Evil Empire saying that they are denying payment for any further visits because, essentially, my insurace plan does not cover OT services for developmental issues unless the issue comes from an accident or illness. In other words, if Frank got SPD from being in a car accident, we'd be golden. A disorder he's had since birth? Yeah, not so much.

I called and asked, politely, WTF was this about??? The first woman I spoke with there said that maybe it was because of the code the provider entered in when they sent the paperwork to insurance, and to resubmit everything. I called the provider and relayed this info.

I would like to take this moment to say that A, the woman who handles all this crap for the provider, is a saint. Anyone who can deal with Evil Empires of all sizes all day long and still smile has to be a saint. A thought it was rather odd, especially since she'd used all the codes she'd been using for the last two years, but resubmitted it. I called today to find out if she'd heard anything, and as it happens, they'd just gotten info back from the Evil Empire today- denied.

So I called the Evil Empire. Representative number 1, after listening to my story, thought it was odd, too. She passed me along to Claims- "Maybe they can figure out what's going on." Claims lady, after looking over my file, said my plan didn't cover this type of OT.

"But you've been covering it for two years!" I said.

"Did your plan change recently?"

"Not that I'm aware of," I snapped.

She passed me along to Appeals, which is the next step. The voicemail at Appeals said that their office hours are 9-5, Monday-Friday, and to leave a detailed message, along with my ID number, and my call would be returned as soon as possible. I looked at my watch while I waited for the beep: 4:15pm. Last tiem I checked, that is 45 minutes before 5pm, which means they should have been answering their freaking phone.

I left the required detailed message, hung up, went to get my kid, bring him home, and told the latest chapter to my husband...and ended up crying out of frustration. (Side note: I am a cryer. I cry with sadness, happiness, at sappy movies, while reading the last Harry Potter book, and with rage and frustration. Poor Darrel sometimes is not quite sure what to make of this.)

They better get back to me and get this sorted out. It's one thing for them to try and screw with me and my health (which they have done in the past, and I almost died as a result), but Do. Not. Screw. With. My. Kid!

In the meantime, since we cannot afford to pay for OT ourselves, we've suspended it until we do get it sorted out. Which sucks, because he really needs it, and I need to talk to D, the OT, about things that come up with the kid.


Anisah said...

I'm sorry you're going through this. I hope things get sorted out and the ebil insurance company has to pay for his OT.



Keri said...

Sounds all too familiar. OT is not covered by our insurance as well (unless it's for rehab) and we cannot afford the absurd cost out of pocket. Like many other families, we are stuck figuring out how to do our therapy at home (which hasn't been going too badly).

It just would be nice to not have to fight for services at every turn, you know?