Insurance Co paying for healthclub

[Alice]

I remember reading apost about someone getting their insurance company to pay for their entire fee or partial fee for health club. Can you tell me how you did this? Want to share the letter you wrote, that would be great. I would like to try and do this. I found a health club close to me that has a pool. I would love to take my BPI child there through the winter for swimming. I wouldn't even mind if they paid for 1/2 the fee. I can't believe the prices these places are trying to get. WOW. Well if anyone wants to share their experiences in this area I would love to hear them. Thanks

[francine]

Many insurance companies now pay for all or part of health club benefits - many companies however, want to know that you are using it and with Blue Cross - you actually have to call this phone line (special phone installed at the health club) to have it automatically check mark that you've been there...and then when you've gone so many times - you can get reimbursed.

But I know you meant about our kids right?

We have Aetna US Healthcare and they (under the 'old' medical excellence system) gave you a membership where there is a pool so that it would extend your child's 60 day aquatic benefit to a year. Of course they didn't pay for the therapy for more than 60 days BUT you got to go to a pool for the rest of the year.

All we had to do was submit an invoice and they reimbursed us.

Unfortunately - the system has changed and Medical Excellence now only deals with the out of state coverage. I doubt we'll be able to get that advantage again. But I'm going to try anyway.

If I were you - I'd just keep on pestering them about it - write letters - have your doctors write letters, etc. Won't hurt to try and push them into it.

Good luck with this!
-francine

[TNT1999]

Hi, Alice. You're probably talking about me. We have Aetna USHC and they have a special program that recognizes special health care needs associated with BPIs. In fact the case manager who was assigned to us (until recently) was also very knowledgeable about BPIs. It was not part of the company's policy to pay for memberships (not even within the medical excellence division). However, I simply explained it to our case manager this way -- I said based on our policy, we have an unlimited # of PT/OT visits within a 60-consecutive-day period. I can either hire an Aqua PT to do therapy 5x/week OR and I can hire the PT to do therapy 2x/week supplemented by me going an additional 3x/week and working with Nicole myself (if I had a membership). I also pointed out to her that at a rate of about $150 per hour, that it would only take a few visits with an Aqua PT to cost justify my request. The case manager thought it sounded reasonable to her and went to the medical director for approval. I never had to give her a letter -- just a brochure from the fitness center. She also incorporated this into the regular benefits for children with BPIs within the M.E. program. However, I'm sure it's not likely to be that easy with most insurance programs.

I would also like to add that she extended our aqua therapy benefits from 60 days to EIGHT MONTHS -- 2x / week during Nicole's post Mod Quad recovery. All this is also at a hospital that is not even a participating provider of theirs!! This is all so amazing to me and not only do I miss our case manager, but will greatly miss the insurance co. / M.E. program when we're forced to change companies next month.

I think that one of the keys to us getting such specialized care and exceptions made is that we had ONE case manager that was assigned to us. This is going to be something I'm going to try to get in the future with any insurance co. Even if there isn't a specialized program, it really helps to have the same contact person all the time (esp. if they're good!). This way they really get to understand your child's needs and you don't have to explain a BPI to them every time you call.

I do believe that most insurance companies offer discounted pool/fitness/health club memberships, but it's often to certain places. I would checkout what locations are availble to qualify for their discounts. If none of the facilities on their list have a heated pool, but the place that you want to go to does, then use that as your argument to go to the health club of your choice.

Here's another suggestion. I've been reviewing several insurance co. manuals this past week in my endeavor to find the most ideal plan for us for next year. In the process, I've noticed that all the plans available to us have a feature called "Flexible Benefits Option." I have to call a couple companies to findout more specifically what that includes and how to become eligible for it, but it sounds like it might be something beneficial to us. Just keep asking around your insurance co. to findout if they have a program for special health care needs. You might find you have to ask several people before one knows about it. I know that the M.E. program at Aetna is a well-kept secret. Well, I'm sorry this is so long. I hope it helps. -Tina

[TNT1999]

Francine, our 60 days was extended to four months (about 2x/week) and then an additional four months were added for a total of EIGHT MONTHS of aqua PT (2x/week most of that time). Our membership also expired during that time (2 months ago) and they reimbursed us for the next year. Anyway, just wanted to let you know in case you have an expiring membership coming up soon. Also, have you actually received anything in writing from Aetna about their NME coverage changing? We haven't. -T

[francine]

no Tina - nothing in writing yet...BUT our new NME case manager has verbalized the changes.... wish I COULD find it in writing - for some reason it seems like everyone is given a different answer....Maia could NOT get the extension on aquatics but they gave us the membership and now we ahve to fight for the new aquatic approvals...hmmmmm

-francine