United Brachial Plexus Network, Inc.

Hey everyone. I have'nt been around in awhile, things have been crazy. I need your help, Peyton has run out of his pt/ot visits, his ot has just got 6 more visits approved, but the insurance company says that they can only work on his hand and not his shoulder! Has anyone else experienced this before and what should I do? How do I go about fighting this?

Hello Marnie,
I'm wondering if the reason they can only work on the hand is because you have a certain # of visits per condition/ diagnosis. If this is the case, you will need to start an appeal process. Gather as much information as you can about this injury, call the insurance company, and ask to speak to a supervisor or a case manager. (case managers are usually registered nurses or have some form of medical background) Hopefully the person you speak with has heard of BPI's. If not, you will find yourself telling the story yet another hundreth time. Stress the importance of the need for PT and OT. You may want to have your PT write a letter of medical necessity for you to fax to them. Make sure when you reach the person who is willing to help, you write down their name, fax #, and direct phone #. I hope this helps:-) Please feel fre to e-mail me if you have any further quesions.
Take Care,
Allison
One more thing, don't take No for an answer. Make yourself a pain in these people's rearends. It's sad we have to fight so hard.

Marnie when my visits run out my OT and PT have to ask for more, but usually they ask for more visits because of another problems. I remember they address his scoliosis, and another was winging. I cant remember the others but usually for each "problem" they gave us 6 months @ 1x a week. Ask the OT to address another issue your child may have. Hope this helps.