Fought the ins co and won!

[susiestar]

Blue,

Not sure if all ins cos can bw forced to do this, but my husband's sis helped me do this:

Our therapist was not covered on our new ins plan (under husband's new job). Only 3 tdocs in our town were on plan, and NO out of plan benefits. Took a month, and lots of calls and persistence, but I got an agreement to let our therapist be on the plan just for us.

I had to argue that my kids showed progress, that I had tried to get in to EVERY therapist in our area, and that we were also seeing a psychiatrist. therapist has to agree to usual and customary fees. (Not a problem).

Our ins made it as hard as possible to get to the right people to get the "ad hoc agreement" but it was possible. And I had to give them LOTS of details about EACH family member. AND LOTS of progress about each family member.

This was after about 2 weeks of being told it was hopeless.

Jsut wanted to share so others could know the tricks to get it done if they needed to!!

Susie

 

[bigblueagain]

as I always say, it never hurts to do appeals thru your insurance carrier. They have to have procedures in place for most everything that can get in the way of medical care. It doesn't necessarily mean it won't take time, effort and lots of phone calls, letters, etc. But it can work.....I also advise when there is such a problem as you face to put in writing that there is a continuity of care or delay in care and that can help your case. Most insurers will allow out of network providers if there is none in a 50 mile radius, or if there is a significant delay in appointments.
Great job!
BLUE