Our insurance denied a request from our pediatrician to increase the boy's therapy visits for the year. They have only approved each child for 60 visits per calender year which Bohdan has already used and Caius only has a few weeks left.
I don't understand how they can say that Caius and Bohdan don't need extensive therapy. The worst part is that since the request has been denied they have sent us over to the Grievance and Appeals department for which there is no phone number or customer service help.
Please pray I can get my boys therapies. I have tried to get the boys Medicaid but in the great state of Texas you have to show medical necessity and they don't qualify.
I'm asking our pediatrician to write another letter as well as each of the boy's therapists, I will include these with my appeal letter to the insurance company. Any prayers, help or advice you can offer would be much appreciated. Thanks.
Praying ours only allows 20 total a year - it's ridiculous.
ReplyDeleteYvette, what do you do?
ReplyDeleteHave you tried the MDCP program? If not look into that. It is a loop hole to get kids on medicaid in Texas.
ReplyDeleteBE blessed
Ashlee
Just a thought, some insurance companies only count it as 1 therapy for 2 on the same day, ie we do OT and PT on the same day and it only counts as one. My insurance only allows 30 per year so I have to appeal every year. The best advice I can give you is to call and request a case manager. That way you always have one person to go to worth everything. Mine is a godsend. Email me if you have any other questions. Christina0469@msn.com
ReplyDeleteChristina
I don't know anything about what Texas offers as far as preschool goes, but in the state I live in, early intervention preschool is offered through educational cooperatives free of charge for at risk children, regardless of income. It is offered to all children of lower income families, but children with special needs such as speech, down syndrome, autism, hearing loss and many more needs are offered preschool free of charge. At these preschools, they are given speech therapy, physical therapy, OT if needed and other services as needed. When it comes time for the child to enter school, a transition meeting is held with the special ed department of the school they will be attending so that an IEP will be already in place when the child begins school, therefore, eliminating wasted time getting the appropriate services for the child from the beginning. I know preschool is not for every family and everyone's choices and circumstances are different. Just thought it might be something to check in to. I know how important early intervention and PT is and I hope and pray something will come along for your boys. They are precious!
ReplyDelete