Re: Re: Therapy denied saying it was restorative in nature

[Guest guest]

yes; I had my neurodevelopmental pediatrician write a letter stating that

Speech Therapy was MEDICALLY necessary and she provided the coinciding

insurance codes. I don't remember off hand what they are but that seemed to

work after about a couple months of back/forth...them losing our file..them

finding our info. on the computer...and finally when I threatened to get a

lawyer involved..miraculously they said they had approved it and sent the

approval to the speech provider (not me!). It is a very frustrating process

but stick with it and I believe it will pay off.

" Jill Henshaw "

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[ ] Re: Therapy

denied saying it was restorative in

02/13/2009 12:33 nature

PM

Please respond to

childrensapraxian

et@...

m

I think you will find many insurance companies do not cover speech

theraoy. Our old insurance company covered apraxia or stuttering. Are

urrent insurance company has even excludedd apraxia specifically.

There are some great websites about how to appeal to an insurance

company for speech issues. Some I may have even gotten from this site.

On that same subject. Has anyone appealed to an insurance company

when they specifically state that apraxia is not covered?

Good luck to you!

>

> Hi I am new to the group! I was wondering if anyone has had denials

> from insurance companies saying they would not cover speech therapy

if

> it was restorative in nature? We are fighting our insurance company

> (Cigna) right now on this issue. My son has been dignosed with

Apraxia

> and we are doing an appeal right now. Any and all suggestions would

be

> greatly appreciated! I just haven't found alot of information on how

> to go about fighting them on this. Please help!

>

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[Guest guest]

Thanks for your tips!  Well, we have had the pediatrician write a letter stating

it was medically necessary, that was what the insurance company wanted us to

prove to begin with.  We thought once we were able to prove it was neccessary

they would cover it. Then the insurance company came back and said they do

believe it is medically necessary and would benefit our child but that it was

not restorative in nature and therefore would not be covered.  They are placing

him under rehabilitive services which he is a child so I don't understand how

they can do that when he never had the ability in order to lose it.  The doctor

did a peer-to-peer review after it was denied with Cigna (which they said was

the last step before going through and appeal) and it didn't help.  Cigna did

agree it was medically necessary but still won't cover it because of the

restorative part.  It's crazy, my husband has Health Advocate working on

appealing the past charges for

therapy because originally Cigna did say they would cover it and then backed

out and then paid less than 1/2 for 3 months worth of therapy and then decided

to stop covering it.  When we asked them about it they said they messed up and

shouldn't have paid it.  Yes, it is very frustrating the insurance company has

said they have lost papers we sent in or never received them and every time we

call we get a different answer from each person we talk to.  Do you know if most

insurance companies cover habilitive therapy cause that is what they are

considering my son to be needing since he didn't lose the ability to talk from

an accident etc.?

Thanks,

Tina

From: myra.bauza@... <myra.bauza@...>

Subject: Re: [ ] Re: Therapy denied saying it was restorative

in nature

Date: Friday, February 13, 2009, 12:02 PM

yes; I had my neurodevelopmental pediatrician write a letter stating that

Speech Therapy was MEDICALLY necessary and she provided the coinciding

insurance codes. I don't remember off hand what they are but that seemed to

work after about a couple months of back/forth.. .them losing our file..them

finding our info. on the computer...and finally when I threatened to get a

lawyer involved..miraculou sly they said they had approved it and sent the

approval to the speech provider (not me!). It is a very frustrating process

but stick with it and I believe it will pay off.

" Jill Henshaw "

<jhenshawnew (DOT) rr.

com> To

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[childrensapraxiane t] Re: Therapy

denied saying it was restorative in

02/13/2009 12:33 nature

PM