insurance company

[Jena]

denied me yesterday. i sat on phone for hours with customer care advocate, than with the doctor's out in california and after all of that they denied giving us a single case approval for the therapist difficult child began with two weeks ago.

it's just beyond me, i'm so frustrated. got on phone again this morning and talked to the union rep for ex h's company to see if he can do anything.

since this began with difficult child i've had more problems with this insurance co that i've never had before.

rep didnt' even get it he was like why would they do that? i said umm if i knew that i wouldnt' need your help. meanwhile looking for new therapist yet it's holiday time no one's around,available etc. i've been down this road before. minimal providers in my area and alot that wont' even touch her said it's and she's too complicated for them and their level of expertise.

so here we sit. odds are hospital again after holidays if i can't get her to eat. i'm soo wiped out it isnt' even funny.

 

[Wiped Out]

Ugh! I'm sorry you are dealing with this. It doesn't make sense to me especially if they let you start with the therapist to begin with.

 

[HaoZi]

I hope you get this sorted out soon, might want to make it clear to them they'll pay out a lot more for her going to a hospital than getting weekly help.

 

[Jena]

it's odd, insurance co. has always been great, yet our level of care was minimal pyschdoc every 4 to 6 weeks and therapy weekly. no hospitalizations, specialists etc. now i've brought all that in and since day 1 with this it's been a battle of them not paying claims, me getting billed 50,000 for hospital. got bill 2 weeks ago and just laughed. ahh whatever is my attitude with the piling up bills. can't get blood from a stone.

 

[smallworld]

You may remember that many insurance companies don't cover treatment for eating disorders. That's what you may be running into. Here's a link to an article in Newsweek:

http://www.newsweek.com/2008/06/23/critical-care.html#

 

[Bunny]

Jena, I'm sorry to hear that you are have a problem with the insurance company. I hope that they finally agree to cover her treatment.

Pam

 

[Jena]

small, yea i know what you mean yet this one isnt' that. their just being difficult because this particular provider is awaiting approval to go into network. she assured me as did rep at company (insurance) that they'd bring her in on single case approval. so that's where it fell apart. she's a therapist yet with a phd strong, aggressive seemed to go well with-rin the first two times. so i decided to give this whole thing a rest till after christmas for myself, just make sure i keep her hydrated fight to get something down and figure it all out after. it's way too stressful

haozi thanks!!

 

[DammitJanet]

Getting a therapist approved by insurance that isnt on their list of approved providers is like nailing jello to a wall.

I have been seeing my therapist for years now but due to the fact that I have Medicare/Medicaid, I cant see her anymore. Problem is she is a LPC. If she was a Licensed Clinical Social Worker (LCSW), all would be fine and dandy. Medicare approves Licensed Clinical Social Worker (LCSW)'s for therapy but they dont approve any other "initials". Now Medicaid does approve LPC's but because Medicare is my primary insurance, I have to go by what they approve.

I have begged Medicare to approve my therapist because there is a loophole in their wording that says "or other qualified professional" but I cant get anyone to manage to figure out how to do this billing...be it on the side of Medicare or this agency...dont know which. A LPC has just as much education as a Licensed Clinical Social Worker (LCSW), they just take a slightly different path. In fact, my therapist is actually a Masters degree LPC and some Licensed Clinical Social Worker (LCSW)'s arent. Gotta love the system.