What is covered for testing?

Discussion in 'General Parenting' started by cmdh, Apr 18, 2005.

  1. cmdh

    cmdh New Member

    This is my first post on the insurance side of things.

    This question has been probably previously discussed but I couldn’t find anything on it in my quick search - It kind of falls between natural and insurance.

    I have been investigating DAN practitioners. I just now found out they exist from a link another member of this site recommended. DAN practitioners subscribe to a natural treatment plan for autistic children via supplements, digestive enzymes, diet etc.
    This is perfect for us &€“ our difficult child does not do well on a medication RX. The side effects typically outweigh any help they provide. She has done well on a restrictive diet and supplements etc but we are seeing a backslide and need someone to help us heal her and not just patch her up all the time.. A DR THAT BELIEVES IN A NATURAL APPROACH! WE HAVE FINALLY FOUND THE RIGHT DR FOR MY difficult child - . the one I chose is a MD in psy AND a MD neurology AND believes in a natural approach AND specializes in ADHD, Autism etc. and that such things as leaky gut DOES have something to do with all her problems.

    SIGN US UP! We can be packed in 10 minutes.

    Now the catch. The heaven sent dr I found charges by the MINUTE¦. To the tune of about 220/hr Does not work with insurance and you are required to have on file an open ended credit card! So now I have to be independently wealthy to get the help for my difficult child she needs. :Hot Head: :panic: :eek:
    by the way another dr that I really liked has a wait list that you will be CONSIDERED for an appointment in MARCH OF 2006! Didn'€™t even get to the $ part of the conversation!

    To my questions€¦ has anyone gone to see a DAN DR? Heard about them .. good bad or indifferent?

    I know it somewhat varies with insurance co’s but as a general rule do they cover things like metal testing, stool sample testing etc… the not mainlined tests. The receptionist told me avg group of tests run about $1,000!

    What are the key words I need to use when calling the insurance co? I don’t want to be red flagged or anything like that!

    Any help on all this would be greatly appreciated!
  2. OTE

    OTE Active Member

    What I used to do for my autistic kid with the insur co was to get the specific numbers that they use for insur billing from the dr's office of the tests that they would do and the cost of each test. This will be a long list with a LOT of numbers. You'll also need the zip code of the place that is doing the work and the name of the lab if they don't do the test internally in the doctors office. take the big list and call the insur co. Go through each one with the cost one by one. If your insur co says that the cost is high ask them what they pay because that's all they'll reimburse for unless you want to go to the next step of fighting them about it. Find out if that provider is on their list and if not, ask them the name of one that is. ie they may say that lab A is not approved but lab B is. Then call the dr back and ask if they can work with lab b. they'll probably say something like they think that lab a is quicker and more reliable but beg if you have to.

    Mind you, every time you see the dr you'll have to do this again and pray that the dr doesn't want to do something they didn't put on your list when you get there.

    Have you tried an autism support group on the subject of leaky gut for provider info, insur co info and such? As you know from this waiting list nonsense, there are a lot of parents doing this who have a lot of valuable info. They may be able to tell you how to negotiate between the dr and the insur co. eg I had one specialist give me a bill for $400 listed as speech therapy. insur co paid it at $75 based on the codes on it. I went back to both and said look... we were there for 3 hours and I'm getting a 25 pg report. How can you say that's worth $75 which is one hour of reg speech therapy? We added codes for oral motor therapy for an hour, written evaluation time, etc, etc and amazingly I got to the $400 easily! So just talk to them.
  3. OTE

    OTE Active Member

  4. cmdh

    cmdh New Member


    Thank you so much!

    You have just taken a load off!
  5. bigblueagain

    bigblueagain New Member

    Since I know work for a company that administers mental health benefits which are separate from the medical health benefits, I would advise to check with your mh carrier to see if they are a carve out from your medical. Then you need to see your booklet for coverage and EXCLUSIONS. We pay for NO MEDICAL tests under our plan, as lab tests, xrays etc are always considered as being done for a MEDICAL condition. This is actually mandated by the employers whose employees we cover. BLue Crosses are notorious for saying anything that comes in with a mental health diagnosis goes thru the MH carrier....even if it is a medical test. We however CANNOT cover them as it is a specific exclusion under the language of the contract. From time to time if you get your employer involved they can supercede the language but only if they are SELF INSURED....meaning it's the companys own dollars, not ours.(We are only an administrator, not an insurer, the employers are actually considered the insurer.) This however at time causes problems as most employers don't want to set a precedence of allowing one thing for one employee as they will have to allow for all. So as I always say and as the article from the link says, get the appeals process down and try to get alllll needed infor on the front end.
    For my part I have never heard of a DAN physician, and from what I see that they are mandating an open account they already know their charges are non-remimbursable by insurers or administrators, and expect you to have pay for them. They probably won't even file any paperwork for you. So I can't advise you to what to do on that issue.