Re: Insurance Questions

July 11, 2002

In a message dated 7/11/2002 11:01:24 AM Eastern Standard Time, niki_jay175@... writes:

Go ahead and call and get the billing code.

I just did before..and she gave me a miscellaneous code of E1399...so when i called the insurance company..she said..oh..since it's miscellaneous...it does have to get preauthorization...and i can't tell you if it's covered....This is so frustrating...i always read here about all the insurance problems....and feel the frustration..but now i really know what it feels like. No one can give you a straight answer.

I'm having my husband call...hopefully he can get this figured out. I hate wasting time..and she didn't even make me an appointment yet...and the insurance company said this could take a week to find out if it will be covered. And the 2 different insurance company thing is really frustrating b/c i could be wasting my time trying to get it covered with this one..if i should be trying with the new one..but the lady at CT couldn't tell me....

Anyway, thanks so much!! I'll let you know how it goes!!

Mom to

July 11, 2002

,

I really don't know what to tell you in regards to which insurance

you should have cover the band. Hopefully some of our members who

are more knowledgeable in the area will tell you what to do. I

wouldn't worry about making the woman mad if you call again. You

need this done yesterday and can't until it is convenient to

someone's schedule. Go ahead and call and get the billing code.

A letter of medical necessity was really helpful in our case, in fact

that was all we needed to get our insurance to cover the bands with

no hassle. I really hope the same goes for you! Good luck!

Niki

Kaylie & Danny (STAR grads)

Phila., PA

> Hi...

>

> I have some questions..

>

> First of all... is getting his helmet soon which i wrote

> yesterday...but the dr had said it would probably be close to a

month by the

> time he gets it...b/c it'll probably take 2 weeks to get an appt

with CT and

> another 10 days to make the helmet.

>

> My husband's insurance is changing as of august 1st....which

insurance am i

> supposed to be going with for this? When i called CT...the lady

wasn't much

> of a help. She told me she would call my insurance and see if it

will be

> covered..and when i explained the situation..she said..well tell me

which one

> you want to go with...i can wait..and i'm like..no i want this done

as soon

> as possible. But if she can't get me an appt until a while..and

then he

> won't get his helmet until after August 1st..then wouldn't it have

to go

> under my new insurance??? I'm so confused...

>

> And also..when i asked her how long finding out if my insurance

would

> take...she said she didn't have any idea...but i'm in a rush

here...so

> doesn't she realize that?

>

> When i called my insurance company..they said to get the billing

code and

> they should be able to tell me if they'll pay or not..but since

this lady at

> CT said she'll call and let me know as soon as possible...i feel

bad calling

> up and asking for the billing code..i don't want her to get

mad..like i don't

> trust her..but i need this done ASAP..and i don't know if she would

be more

> effective in getting the answer and/or getting it paid...

>

> Also..i do have a letter of medical necessity from the dr...does

that really

> help??

>

> Thanks,

>

> Mom to

July 12, 2002

Oh , I feel so bad for you. I know all this insurance stuff isn't easy,

especially

when it is for issues that are not the norm (and this may become the norm very

soon).

What I do want to share with you is something that may help you to understand

insurance issues and not bang your head against a brick wall. When providers

are not participating with your insurance company, they are not responsible

for calling your insurance company for authorization or to find out if it is

covered. If they do, they are being nice and doing you a favor. It technically

is your responsibility to do the " footwork " with your insurance company. I

don't mean to sound harsh at all, but this, unfortuantely is the reality of it.

So

if CT does half of it or doesn't seem to " fight " for you, they really doesn't

have

to, " technically " . I know that CT in Paramus is swamped and that may be the

reason why

the don't want to take the extra steps.

You definitely will not get an answer over the phone from your ins co. Getting

an approval

in a week actually sounds very good compared to some other insurance

who can take longer. Yes, some are better but some are worse.

Have CT send in a description of the band. The E1399 code is a generic

code that is used when there is no specific code for services. Hopefully they

(the Health Care Financing Agency) will make a new code soon but until then,

you will have to have CT send in a

description of the band and therapy along with your letter of medical

necessity. In terms of what ins co to send it to, call your current ins co

today and ask them what their policy is when ins changes in mid-stream.

Some ins companies will pay for the entire therapy because it started when

their coverage was in effect. If that is the case with your company, I'd send

all the paperwork to both insurance companies to see who will pay. If

CT doesn't want to do that, then ask for the paperwork and send it yourself.

Unfortunately, some people will not go the extra mile if they don't have to

but it might not be because they don't want to, it might be because they

can't due to them being very busy. And I know the Paramus office is

busy. They are even interviewing for a new OT to help Charlotte out.

I hope this helps and I don't mean to sound harsh but I just want you to

be aware of the circumstances that may be holding you up and how to

get around it. Unfortunately, you are probably the best person to get this

stuff done. Don't wait for them.

Good luck and let us know how you make out.

ann/

NJ

DOCband 2 weeks 2 days

> Message: 18

> Date: Thu, 11 Jul 2002 11:05:38 EDT

> From: Av@...

> Subject: Re: Re: Insurance Questions

>

> In a message dated 7/11/2002 11:01:24 AM Eastern Standard Time,

> niki_jay175@... writes:

>

> > Go ahead and call and get the billing code.

> >

>

> I just did before..and she gave me a miscellaneous code of E1399...so when i

> called the insurance company..she said..oh..since it's miscellaneous...it

> does have to get preauthorization...and i can't tell you if it's

> covered....This is so frustrating...i always read here about all the

> insurance problems....and feel the frustration..but now i really know what it

> feels like. No one can give you a straight answer.

>

> I'm having my husband call...hopefully he can get this figured out. I hate

> wasting time..and she didn't even make me an appointment yet...and the

> insurance company said this could take a week to find out if it will be

> covered. And the 2 different insurance company thing is really frustrating

> b/c i could be wasting my time trying to get it covered with this one..if i

> should be trying with the new one..but the lady at CT couldn't tell me....

>

> Anyway, thanks so much!! I'll let you know how it goes!!

>

> Mom to

>

> [This message contained attachments]

>

May 3, 2003

Hi, Beth. I believe " maintenance " means no further progress is expected.

Have your therapists write letters indicating that progress IS expected, to

counter their argument that therapy at this point is merely maintenance.

Sandy, Illinois (alpy2@...)

May 3, 2003

Hello Beth

My son had a velo study done last summer. It is similiar to the swallow

study I think. had reflux as a baby & into his toddler years. The Dr.

that I went to when he was young would never listen to me when I would

explain how everything would run out his nose when I fed him. He was never

on the charts as a infant & up till about 5-6 weeks old was failure to

thrive. He is now a VERY picky eater & has major sensory issues going on.

When he talks it sounds very hypernasal. What they found from the Velo was

the structure was fine, just very weak muscles in the area. Causing air to

flow right through instead of closing off to form a seal, so to speak?? Of

course when they gave me the report it said all the proper medical terms

which I didn't understand but that is how she explained it to me on my

terms!

Tammy I. in FL mom to 5 apraxic, 7, 18 stuttered as a

young child & 22 to be married this coming Saturday WOW!

From: " bethster_99 " <bethster29@...>

Reply-

Subject: [ ] Insurance questions

Date: Sat, 03 May 2003 16:46:12 -0000

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May 3, 2003

Yes my daughter has had two swallow studies done and feeding therapy. What did

you want to know about it? We just had another one done last week to develop

goals for her IEP next year. She's going into first grade which means eating

lunch at school.

Tammy

[ ] Insurance questions

Our insurance recently denied our coverages for speech, OT and PT for

my son, Zack.They stated that it was maintance at this point. He

can't even speak even close to the level of his peers. Does anyone

have any suggestions on this. I appealed and was denied.

also has anyone been referred for swallowing tests/studies?

Thanks,

Beth

May 4, 2003

Were they difficult for her to go through? My son is 7-years-old. They are

trying to determine if there is anything that can be done surgically or not. I

was just curious if anyone had anything successful come out of it. Thanks for

the reply.

Re: [ ] Insurance questions

Yes my daughter has had two swallow studies done and feeding therapy. What

did you want to know about it? We just had another one done last week to

develop goals for her IEP next year. She's going into first grade which means

eating lunch at school.

Tammy

May 4, 2003

thanks for the info. I guess they are questioning if there is something

structurally going on or if it is purely a motor (timming =) issue. I was just

curious if anyone had anything interesting come out of the studies. Thanks a lot

for replying.