Re: Advice for Difficult Insurance Company related issues

[Guest guest]

I would love some direction on this topic. Can you tell me what all I can expect

from a case manager? My daughter has one (nonverbal, apraxic, hypotonia) but

every time we request something, the case manager says we have to go somewhere

else. Things like:

- The insurance company consistently pays the providers instead of us when every

receipt is clearly marked paid in full.

- There are old diagnosis codes (developmental delay) that they use to refuse to

pay since she is over 3 so I have to appeal and point out that her current

diagnosis is one that is covered (and I have documented emails and conversations

to prove that but they still deny every time anyway and I have to appeal EVERY

claim)

The only thing that has gotten easier is that I can call the case manager to get

a new referral. other than that, we have not received a lot of help from her.

But I don't know who to ask about what exactly we can expect from a case manager

because the insurance company won't tell me.

By the way, the only way I knew to request a case manager was because I got a

broad hint from someone somewhere along the line at the insurance company. It

was obvious that they could not directly tell me about getting a case manager,

but if I knew enough to ask, it could be done.

B.

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> Hi Guys-- Happy New Year!

>

> If any of you have multiple forms of therapies for your child with Apraxia...

(and multiple headaches from your Insurance Company), PLEASE TRY THIS.... When

you call your Insurance Company, ask for " A Case Management Referral " for your

Child. Be firm about this... because some of the bozos who answer the phone may

not realize that this even exists.

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> Hugs to all-

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[Guest guest]

I know will get back to you on the case manager -but also wanted to point

out there's a huge amount of info on this topic too here in the archives and at

our http://www.apraxia.org page here is a page that has 3 large messages from

me on insurance and speech coverage

http://www.facebook.com/topic.php?uid=115029735601 & topic=13830

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[Guest guest]

- are you sure about the 384.69 dx code? The Late Talker book says

784.69. just double checking. thanks!

-Rima

> >

> > Hi Guys-- Happy New Year!

> >

> > If any of you have multiple forms of therapies for your child with

Apraxia... (and multiple headaches from your Insurance Company), PLEASE TRY

THIS.... When you call your Insurance Company, ask for " A Case Management

Referral " for your Child. Be firm about this... because some of the bozos who

answer the phone may not realize that this even exists.

> >

> > Hugs to all-

> >

> >

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[Guest guest]

We pay in advance because I am never sure if the insurance company will actually

pay for services since I have to appeal everything. They have yet to simply pay

out on a single claim since my daughter turned 3. My providers are individuals,

not in multiple-person practices. We have Kaiser and my providers are not in

network, but are paid as such because they were referred by the PCP.

Thank you all for the discussion and the links to the information pages. I am

learning so much.

B.

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>

> Hi all-- It sounds like a few of you are paying in advance for Services and

then getting reimbursed by Insurance. Are your Provider's Offices insisting

that things be done this way.... or is it the Insurance company? Are the

Providers that you go to " out of network " )?

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> Take care all...

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