time to battle with insurance company

Discussion in 'General Parenting' started by ksm, Aug 25, 2011.

  1. ksm

    ksm Well-Known Member

    J was supposed to have already had her two hours of psychological testing done two weeks ago... it was postponed as they were still waiting on Cenpatico (the company that decides what the insurance company should pay for). We were rescheduled for Tuesday next week - so I call the office to see if it was still on and if they had had approval and they had sent a denial letter. If we do the testing, we will have to pay for it.

    Two days ago, we saw family doctor and he said he would refer us to the neuropsychologist (listed in the Cenpatico handbook) so I am sure they will be denying that too. I called our insurance company and started the appeals process. Right now, I have just left a voice mail for the person, but at least I got a name and extension number.

    Their reasoning is: psychological testing is not necessary for ADD/ADHD. Duh. I know that. What about the rages? the meltdowns? the hiding in closets? the hiding under the bed? the thoughts of hurting herself or others? the bipolar biomom? the year in foster care? the alcohol and drugs that were used thruheavily during the first two trimesters? the separation from her older brother when he was placed elsewhere?

    WHy can't things be easy? Why do you have to fight tooth and nail for the benefits your child should receive? Time to warrior up. KSM
  2. keista

    keista New Member

    Can you ask the Dr to write to the insurance co and include some of these concerns?
  3. ksm

    ksm Well-Known Member

    The doctor is aware of everything... so I don't know what diagnosis codes he used for the visit or the reason for referral - but I assume he will document it. The therapists office has been using ADD as one of the diagnosis in the past. Which is true. But that is the tip of the iceberg. But ADD was the reason we saw the PRNA and got the Strattera. Cenpatico is the company that runs the mental health portion of their health insurance. It is not quite "medicaid" as we don't qualify for that, but it is for low income families. Only the children are covered by it. Just a pain. KSM
  4. Liahona

    Liahona Guest

    Go get them.
  5. DammitJanet

    DammitJanet Well-Known Member Staff Member

    You have to get the right ISdN numbers. Get the doctor to write the referral with the correct codes. that will work. You just have to play the game and Im sure your doctor knows how to do it.
  6. ksm

    ksm Well-Known Member

    I did diagnostic and procedure coding for 20 years when I worked in medical office. Of course they were fracture codes, infection codes, etc. But if I have to, I will get a paper copy of the HCFA 1500 (most companies file electronically) and do some investigative work myself. I did that when I had shoulder surgery and found out that the surgeon's office billed for rotator cuff repair instead of rotator cuff debridement as was in the operative report. They had to refund the insurance company the difference. KS