Insurance denial...

Discussion in 'General Parenting' started by ksm, Nov 22, 2011.

  1. ksm

    ksm Well-Known Member

    The neuropsychologist wanted to order neuropsychologist testing on difficult child... and they are denying. First, they want to see the results of testing done at the school... which we have not had done. I have called the neuro's office and left a message for them to call me back. I have 30 days to start the appeal process. I have also called and left a message at the school to see what testing they can do. I don't know if they will do any on her - as most the time she is an average student. But she is only an average student because I do all the work - tracking down school work, taking it to school and even handing it in, etc. If I don't do my job... she fails. Which happened on first trimester. one F and two C-'s in core subjects.

    I hate waiting on phone calls - and having insurance companies that play God and lets children fall thru the cracks. KSM
  2. Ma Kettle

    Ma Kettle New Member

    Hi ksm-I saw your post awhile ago, but wasn't where I could respond. So I had some time tonight and wanted to reply. Sorry it took so long!

    First off, you have to jump through their hoops. It hoovers, I know. But, I have some advice for after you have gotten the school testing and submitted the appeal. It is a pain, and takes time away from you, but you have to follow up with them every day. Call daily to check up on the denial. Keep track of who/what/when/where you talked to them. Have the HR person through whoever's work your insurance is through call daily, asking for an update (make sure you are with them for the first call so you can tell the insurance company that they can talk to the HR person about your claim-this is due to HIPAA). Have the neuropsychologist doctor/office call daily/often explaining why the test is necessary and asking when they can make an approved testing date. Keep all written correspondence to/from insurance company. Go higher up the ladder as needed/possible. The squeaky wheel gets the grease.

    I have seen this work countless times in my place of employment. Don't want to say much more about that, but I do have a story that I can share where this worked.

    My neighbor's daughter had size GG breasts at the age of 13. Poor girl had to go physical therapy, as they were hurting her back. When she was 17 her doctor requested a breast reduction. Insurance denied it as cosmetic surgery. The mom/HR/Dr. office/Physical therapist did all the above. The mom also mailed a package to the insurance company. Inside the package where two bags, filled with rocks that made each bag weigh as much as each breast. They finally got the reduction approved.

    Here's hoping it all works out. Just wanted to share what I have seen/heard and done. Good luck to you!

    Ma Kettle
  3. buddy

    buddy New Member

    aww ksm, i missed this. sorry you are gonna have to don the armour again. But you can do this. Silly to put it off on the school. One thing, when you are making your request, do not emphasize the school stuff other than how it impacts at home. The reason is that they know it is law for schools to test for things that impact school. You are looking for overall answers (and yes, I know it is nit picking and you will get answers that affect school but just for terminology and insurance). this happens in every therapy field. In schools we are not allowed to do "medical" therapy..... so dumb, like you can separate, but we have to relate the goals to something in school, luckily it does include social issues. But it is the wording that makes it happen. In the medical setting I would never be able to work on language to help improve reading scores... you get the idea.
  4. SearchingForRainbows

    SearchingForRainbows Active Member


    Sorry you have to go through this - been there done that and it rots! In order to get as much help as possible for difficult child 2, I stopped helping him with his schoolwork. As hard as it was to watch, I let him fall flat on his face. I know this isn't the answer for everyone but it worked in our case. SFR
  5. ksm

    ksm Well-Known Member

    I had tried making calls on Tuesday last week - but didn't get very far as everyone was headed in to a 5 day weekend at school here. I did get a call back from the school yesterday and they are willing to do an IQ and academic testing. I called the neeuropsych's office and asked if those were the tests they wanted the school to do - and was told that they have notes on it and the neuropsychologist needed to speak to a specific person at the insurance company, but with the holiday, it hadn't happened yet. I was told not to start the appeal process yet or do school testing yet. I guess we need to wait and see what happens after they communicate.

    I really don't think IQ or academic testing would be beneficial. difficult child tests out above average on state assessment tests since dher started taking them. She reads at 11th grade level (probably has since 6th grade) and is an 8th grader. Math is hard. English grammar is difficult, but reading is good. I hope to hear back by the end of the week. Still crossing my fingers. If not, I will start the appeal process.

    MaKettle - the insurance is a childrens insurance thru the state... so of course they will stall and cut corners all that they can. I love the sacks of rocks!

    Buddy - thanks for responding. It is just so hard to get help for a child that looks "normal" to everyone else. It is mainly at home that things fall apart. KSM
  6. ksm

    ksm Well-Known Member

    We have had this insurance policy since we adopted the DGD's. It was not a state adoption, but a private adoption, even though they had been in custody of the state for 2+ years. It is not medicaid - but a policy we pay for based on our income. We could put them on our family policy - but it has been cheaper to not add them because of the copays for visits, rx, glasses, dentist. If we add them - we lose the state children's insurance.

    Last year, I had a problem with getting them to pay for easy child's glasses. When I went to purchase them, we were told we didn't have coverage. I went home, found my letter saying our insurance had been approved for one more year. Called the ins company and was told, oh, it was just a computer glitch, we have had no loss of coverage. Well, we got the glasses, but then they didn't pay for them for 4 or 5 months! The eye glass shop kept getting denials that we weren't covered for the date we got the glasses!

    I made many calls, and hunted on the website for the insurance until I found real people with email's and started contacting multiple people. I kept getting told it was was all taken care of. But the glasses never got paid for. I finally called the State Insurance Commissioner's office and was told they could only help with problems for private insurance... not state insurance!!

    I was persistant and finally got it taken care of -but I was MAD! I would guess that the majority of people with state insurance would not have taken the time and persevered to get it taken care of and would have paid out of pocket for things the ins company was legally liable for.

    I have worked in medical offices and did medical coding for diagnosis and procedures, filed insurance, posted insurance to accounts, and made numerous calls to get things precertified. I know the language and what is covered and will push. But right now I will wait and see what the neuropsychologist can do on her own.

  7. buddy

    buddy New Member

    now there is a can tell them how to put things. and it is a good thing for all of us! we know who to come to, smile!!!!

    But seriously, I am sorry something that seems so obvious has to be such a fight.... really sorry.
  8. buddy

    buddy New Member

    hey, just thinking, does your county or the county they were adopted from have a post adoption services department? They may be able to help you ammend your agreement. or add to it? or whatever they have... I don't know. Some of the post adoption programs have their own resources... and then there are places where there are no post adoption services, but just checking in case... (you probably have done all that anyway, so sorry if it is an old idea.....)
  9. ksm

    ksm Well-Known Member

    Since this ended up being a private adoption - we have no state/government resouces. It is a long story, our GDG's are tribal members of an Alaskan federally recognized tribe. There is a federal law (ICWA) Indian Child Welfare Act that has rules that has to be followed on Indian Children - because in the past, Indian children were adopted out from their family and relatives at a much higher rate. To terminate the parents rights is very difficult. So instead of doing things by the book - SRS threatened that when the parental rights were terminated, they would place the girls with strangers, even though they had lived with us for over a year, and we had always been very active in their life since they were born. Then the judge asked the parents if they would sign a form naming us the adoptive family. My son and his ex agreed. Then we were told it was a private adoption and we had to pay all the atttorney fees, lost their medical card and the monthly benefits they should receive until they are 18.

    By doing this, the state attorney did not have to follow ICWA law, the judge didn't have to have a drawn out courtroom trial, SRS wasn't responsible for all the ICWA laws they had broken. But the girls (and us) lost out on all benefits. Can you tell I am still mad 7+ years later??? Even a couple hundred extra a month would make a big difference in what we could spend on activities, sports, clothes, tutors, trips with the girls. KSM
  10. buddy

    buddy New Member

    Oh KSM, so sorry. One of my dear friends is Lakota and her adopted son is too. We have gone to visit them and I even went to a native american conference she came to in our state and was able to meet many of her friends and get a little bit of education about the unique issues.

    Yeah, you have a right to be upset.

    So, we have post adoption resources here even for private international adoptions.... any chance there is that kind of help? I bet it is not the usual.
  11. ksm

    ksm Well-Known Member

    Where we live, there is a Children's Service League... which handles most of the state adoptions and after care. But,I'd rather not deal with the same group of people who were so unethical in the past. We had a family support worker and a CASA worker who actually warned us about 6 months before the adoption that our DGD's were "highly adoptable" meaning that the agency would like to have them for their "adoption pool". I said, so if my DGD was in a wheel chair, I wouldn't have to worry about the chance of not keeping her? And she said "sadly, that is so." I am so burnt out on "the system" in our state... It was the first state to "privatize" the foster care and had companies "bid" on the state contracts. So that agency only made money based on how many kids they had and how long they kept them in foster care. Then they got a cash bonus for every adoption they did.

    I would not have believed that this is how it works until we were thrown in to the system. KSM
  12. buddy

    buddy New Member

    It just makes me ill to hear that. I am so sorry you had to go through that and I would avoid them at all costs too. just pure yuck.
  13. TerryJ2

    TerryJ2 Well-Known Member

    I agree with-the others, that you should not wait for the ins company or school--you have to be a pitbull and stay with-them every single day. You almost have to treat the system like a bunch of g's fg, Know what I mean??
    I'm sending strength.
  14. TerryJ2

    TerryJ2 Well-Known Member

    P.S. I'd also get the dr on the ph with-the inc company. I love it when doctors chew out ins companies!!! :)
  15. ksm

    ksm Well-Known Member

    That is the plan... If I don't hear back by Friday, I will call the neruopsych's office back. The clerical staff seems to be up on it - said she had two notes on her desk and that the Dr. will facilitate the call... but I am sure it doesn't happen quickly - nothing happens quickly with state insurance. The doctor probably has limited times for phone calls - and the person that they are calling probably doesn't sit waiting for calls. Hopefully it will happen soon. I have almost 30 days to start the appeal process... but it will be easier if we get verbal ok. If I go the appeal route, I am sure I iwll then have to wait for school testing. I will be keeping up with all of this. KSM