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General Parenting
Trying to understand Ins. Company's denial
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<blockquote data-quote="TLF" data-source="post: 4115" data-attributes="member: 326"><p>Hi Big Blue,</p><p>First of all, you are WONDERFUL for even doing this!!!!! :laugh: Insurance is such a confusing mess for the rest of us!</p><p></p><p>My 6-yr-old son was recently denied coverage, and I'm trying to understand the letter from our ins. company.</p><p></p><p>Some background: He was evaluated by a neurologist who reported "significant for possible auditory processing symptoms . . . significant neurologic abnormalities--difficulities with speech articulation, finger apraxia, weak hand intrinsics, finger chorea,clumsiness of gross motor movements, impaired tandem balance, and significant sensory processing symptoms."</p><p></p><p>He then was given an evaluation by an Occupational therapist who agreed with her findings and recommended Occupational Therapist (OT) for 6 months or more.</p><p></p><p>Our insurance co. is Regence Blueshield, with a plan called Boeing Traditional that apparently is packaged for the employees at management level and is not as liberal as what they provide for union employees.</p><p></p><p>Their letter to us stated "the documentation submitted (both the neurologist's and Occupational Therapist (OT)'s reports) did not clearly establish an underlying illness or injury in the prenatal, perinatal or early childhood timeframes, as required by the Plan for consideration of medical rehabilitation benefits."</p><p></p><p>This makes no sense to me! My son has to have been actually "injured" to have something wrong with him?? Can you shed any light on what they mean . . . and is there anything I can say that would have any impact in an appeal?</p><p></p><p>Thanks SO MUCH!!! I'm sure this takes a lot of your time . . . and is SO appreciated!</p><p></p><p>TLF</p></blockquote><p></p>
[QUOTE="TLF, post: 4115, member: 326"] Hi Big Blue, First of all, you are WONDERFUL for even doing this!!!!! [img]:laugh:[/img] Insurance is such a confusing mess for the rest of us! My 6-yr-old son was recently denied coverage, and I'm trying to understand the letter from our ins. company. Some background: He was evaluated by a neurologist who reported "significant for possible auditory processing symptoms . . . significant neurologic abnormalities--difficulities with speech articulation, finger apraxia, weak hand intrinsics, finger chorea,clumsiness of gross motor movements, impaired tandem balance, and significant sensory processing symptoms." He then was given an evaluation by an Occupational therapist who agreed with her findings and recommended Occupational Therapist (OT) for 6 months or more. Our insurance co. is Regence Blueshield, with a plan called Boeing Traditional that apparently is packaged for the employees at management level and is not as liberal as what they provide for union employees. Their letter to us stated "the documentation submitted (both the neurologist's and Occupational Therapist (OT)'s reports) did not clearly establish an underlying illness or injury in the prenatal, perinatal or early childhood timeframes, as required by the Plan for consideration of medical rehabilitation benefits." This makes no sense to me! My son has to have been actually "injured" to have something wrong with him?? Can you shed any light on what they mean . . . and is there anything I can say that would have any impact in an appeal? Thanks SO MUCH!!! I'm sure this takes a lot of your time . . . and is SO appreciated! TLF [/QUOTE]
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