From the moment Bubba was diagnosed with PDD-NOS, I began weaving my way through the upside-down world of insurance. As I picked up the new language, I began speaking in diagnosis codes and specific procedures. Reading insurance law and regulations became my pastime. It seems relatively straight-forward, but it never works out that way.
One week ago, I was approached by the business director of our therapy center. Let me just say from experience... the business director doesn't want to see you, much less call your name, unless there is a problem. So, I grimaced as soon as I heard Ms. Gregory roll off of her tongue. She quickly and matter-of-factly explained that Evander's new insurance, CIGNA, only allows a combined 60 visits for therapy, and Spencer has two visits remaining in speech (and 4 in OT). They can apply for reauthorization but usually don't get it.
Immediately my heart sunk.
I asked all the appropriate questions, the most important coming first: Is the appropriate diagnosis code on the paperwork? Texas recently passed a law requiring insurance companies to pay claims associated with Autism therapy. What I just found out, however, is that they do not have to pay ALL claims. We were allotted 60, so that is it.
How can they let this happen? My son relies on weekly therapies, and he is in danger of losing that. He has come so far and continues to grow. How much is one 30 minute session you may be asking? Afterall, it is only 30 minutes for one therapy. It is $109...the same amount as ONE college class for me. $109 pays for 4 1/2 months of education or 30 minutes of therapy.
What is wrong with healthcare? Here you go!!
No comments:
Post a Comment