Insurance still won't cover post op PT

[Mary]

I just need to vent. Our insurance company, after a week, still has denied covering Sarah's post-op PT. I have contacted the provider's that they have told me and those providers are unable to treat her 1 due to staff on leave of absense, the other because we do not live in the same county. My local hospital won't even provide pt for her due to her age and "condition". I fought with the insurance co yesterday for over 4 hours. I have called my state insurance commission. They gave me a name of a person to call at the company. I did that and I don't think it has helped.

How do you make these people understand that now that she has had surgery, and even before, pt is critical to achieve what she suffered through surgery to obtain??? I could just scream at the top of my lungs.

I did also call my personnel office and got their contact at the insurance co and called them also. If on Monday by 10:30, they have not found me a provider to treat Sarah, I plan on calling my state reps and senators as well as my attorney and the media. There has to be an end to this. We can't afford the $130.00 per visit once let alone up to 3 times a week for 12 weeks. Just needed to vent to those that I know really do understand. Thanks for listening.

[francine]

Jenniffer said it best - it's a bunch of crap. With our insurance each time you have a surgery, you have a new diagnosis and therefore and new allottment of therapy possibilities.

Contact the governor's office - contact your state representatives... contact your attorney. Therapy is crucial for our children especially post surgery! why do they pay for the surgery if they can't finish it with the therapy to complete the process.

You just keep on venting to us Mary and you keep on finding that strength and that power within you to fight for your child. You are a strong woman, a lioness looking after her cub, and you will protect your child and get her what she needs. Don't back down ever!

Let us know if there's any way we can help you.

But in the meantime, big hugs to you,
francine

[Mary]

Thank your for all your support. Our insurance is a HMO. It isn't that there dening that she should have it, there just isn't a provider within "their network" therefore, they don't want to pay.

A bunch of crap is a great way to phrase it. In the event we go to media, at least it will be good pr for the injury and may even help others not have to reinvent the wheel when their kids need services.

Thanks for listening. Hugs to you all.

Mary

[Carole]

I know how hard it is Mary before Kaitlyn I fought for years for my son Patrick who has SI and ADHD to get OT services and then services after his hand surgery. What has worked for us is to go throught the process of appeal if possible in this case and to have your Doctor write a note fighting for you for out of network providers - get you local ped or your surgeon's office to call and write - there is a process for that. If you already did that you could go for one visit- not pay for it and then do the whole appeal thing on it. That worked for us. Also contact a lawyer= ken Levine told me if I had not gotten pat's OT covered he could easily handle it- just an idea. maybe a quick letter from an attorney would help. In every letter I quoted my states insurance board too. Good Luck. How is your sweetie? carole

[loz1969]

God I feel for you. It's times like this that I realise how lucky we are in 'little old UK'. knowing that we can get treatment without selling our homes or our soles, or the need of endless battles with insurance companies. I know that some of our hospitals are, lets face it, pre-historic, and our waiting lists can some times seem endless, at least we all get treatment in the end. My heart goes out to you. All i can offer you is the knowledge that our thoughts are with you. I hope it all gets sorted soon.

[francine]

we just went through a major fight to get Maia's orthotics.... We got the evaluation done by Dr. Nath and Leslie McKibben..and then at Dr. Shenaq gave me the prescription for it. But the insurance company wouldn't pay for it because he is a plastic surgeon... like maia is having cosmetic surgery on her feet or something. We had to go through all these levels of appeals and had Maia's primary doc write letters and fill out forms to explain to them that it's medically necessary (like orthotics wouldn't be medically necessary) and finally - two months later, they were approved.

[Mary]

I know that there are appeals and normally I wouldn't mind running the race by their rules. However, this is just after surgery. There isn't a lot of time to mess around with their 20 working day turn around time. Historically, they deny us again regardless of the documentation that we have provided.

Thanks again for the support. Tomorrow, hopefully, will be a good day.

[admin]

There is a program in my state called First Steps. I don't know where you are or how old your child is, but it provides FREE PT until age 3. It has nothing to do with income either. It is for all children with a disability. My daughter has benefitted from it since she was about 1 year old. Please feel free to email me with any questions.

bethakerr@cs.com