MommyX8 Posted January 15, 2013 Share Posted January 15, 2013 The verdict is in. It is possible to get your insurance company to pay for vision therapy. We have United Healthcare. They have been awesome although I did have to babysit my claims, which really isn't a surprise. I brought my son to a local VT (COVD.) That appointment was $325, which I thought that I was going to eat since he was an out-of-network provider. But, it gave me the medical necessity report that I needed to get the insurance company to precertify that my son does indeed need the services. Next, I scoured through the COVD list and cross-referenced with my health insurance company to find an in-network provider. I found one about 1.5 hours away. I double-checked that the therapy code was the same. So that is when I applied for a gap exception. With UHC, if your closest in-network provider is more than 30 miles from your home, they will pay the difference between the out of network price and the contracted in-network price. In my case, my local guy charged $145 per session, whereas the in-network contracted price was $34.68. So then I submitted my first month's worth of claims. Well, the insurance company went ahead and processed the entire 48 visits of vision therapy. My initial price for VT was $7780. My bottom line out of pocket is $228. So it can be done. It just might take some work. Blessings, Kim 3 Quote Link to comment Share on other sites More sharing options...
jujsky Posted January 15, 2013 Share Posted January 15, 2013 You're lucky. Ours flat-out refused, and said it is not medically proven to help. We appealed it and got the same response. Our insurance at the time was Blue Cross Blue Shield. Quote Link to comment Share on other sites More sharing options...
lcook Posted January 16, 2013 Share Posted January 16, 2013 We had a year of vision therapy covered through United Healthcare. We also got a gap exception. Quote Link to comment Share on other sites More sharing options...
calledtobehome Posted January 18, 2013 Share Posted January 18, 2013 Can up tell me what medical terminology or code is being used? We have Aetna and I'm not sure if it will be covered for us Just yet. 1 Quote Link to comment Share on other sites More sharing options...
amo_mea_filiis. Posted January 20, 2013 Share Posted January 20, 2013 Ds's was fully covered by his insurance. We did 6 months but have not finished due to behavior. Quote Link to comment Share on other sites More sharing options...
6wishes Posted January 23, 2013 Share Posted January 23, 2013 Thanks for posting! I just made vision appointments today for kids, one I'm wondering if she'll need some vision therapy. It's with a local COVD, and we carry United Healthcare Vision! I will say, we changed healthcare from them because they would not cover a neuropsych eval :/. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted January 23, 2013 Share Posted January 23, 2013 Chiming in to say blue cross and Aetna specifically exclude VT in their list of non covered services. Quote Link to comment Share on other sites More sharing options...
calledtobehome Posted January 23, 2013 Share Posted January 23, 2013 ); Quote Link to comment Share on other sites More sharing options...
faithfulmama Posted December 2, 2013 Share Posted December 2, 2013 I know this is an older thread, but I am in the process of trying to get coverage for vision therapy for my son through UHC and was wondering how it went for you Kinsa? Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted December 3, 2013 Share Posted December 3, 2013 We also cannot get it covered with BCBS. My plan is to start the therapy in January so the cost will go toward our out of network deductible. Once we hit a certain amount, they will contribute toward out of network expenses. That won't happen with the vision therapy but it might be helpful if we decide to to an np eval later in the year. :) Quote Link to comment Share on other sites More sharing options...
prairiewindmomma Posted December 3, 2013 Share Posted December 3, 2013 Aetna and CIGNA specifically exclude...we just switched plans. Would you please pm me the diagnosis codes the claims were filed under? Quote Link to comment Share on other sites More sharing options...
A home for their hearts Posted December 5, 2013 Share Posted December 5, 2013 We only have vision insurance through united health care. I'm wondering if therapy will be covered through the vision insurance or if it's covered under medical? Quote Link to comment Share on other sites More sharing options...
faithfulmama Posted December 10, 2013 Share Posted December 10, 2013 I thought it was a medical benefit, but I'm not completely sure. I have just found and made an appointment for an evaluation with a practice that actually directly bills insurance. So I will come back and post info on how that process goes for us. Our appointment is in January. I found this document online: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Visual_Info_Process_Eval_Orthoptic_Vision_Therapy.pdf It lists a lot of exclusions, including rehab from a neurotrauma which is our underlying medical diagnosis. So if my son doesn't have convergence insufficiency specifically, I'm not sure if we will be covered. Quote Link to comment Share on other sites More sharing options...
Guest mikkelborg Posted March 19, 2014 Share Posted March 19, 2014 Hi -- I am looking into vision therapy for my 9-yr daughter and came across this posting. I've gone to the www.COVD.org website and have located a few doctors in my United Healthcare plan; however, those doctors are not Board Certified (they are not "fellows," but "associates"). A Board Certified doctor is more than 30 miles away. Do you recall if NO docs at all from your insurance plan were listed on the COVD website, or were no "Board Certified" docs not listed? Thanks for replying to this old post! Quote Link to comment Share on other sites More sharing options...
Greta Lea Posted March 26, 2014 Share Posted March 26, 2014 You're lucky. Ours flat-out refused, and said it is not medically proven to help. We appealed it and got the same response. Our insurance at the time was Blue Cross Blue Shield. We have BC/BS too. Last week I called to see if my ds would be covered for VT. Since it's a muscle issue, they said that would be a medical issue and be covered under medical. Hmmm....I'm gonna call again to MAKE SURE this is correct. Quote Link to comment Share on other sites More sharing options...
Tap Posted March 27, 2014 Share Posted March 27, 2014 United Healthcare has said they do not cover vision therapy under my husbands policy. We have excellent coverage, but the employer did not purchase that rider on the insurance plan. There are less than 100 employees in the USA who work for my husbands company and they are spread all over the US (he is the only one in our state) so it isn't really worth the battle with HR to try to get them to buy the insurance rider. Quote Link to comment Share on other sites More sharing options...
Julie of KY Posted March 27, 2014 Share Posted March 27, 2014 WE have Humana and VT is specifically excluded on our policy. Quote Link to comment Share on other sites More sharing options...
PeterPan Posted March 27, 2014 Share Posted March 27, 2014 Hi -- I am looking into vision therapy for my 9-yr daughter and came across this posting. I've gone to the www.COVD.org website and have located a few doctors in my United Healthcare plan; however, those doctors are not Board Certified (they are not "fellows," but "associates"). A Board Certified doctor is more than 30 miles away. Do you recall if NO docs at all from your insurance plan were listed on the COVD website, or were no "Board Certified" docs not listed? Thanks for replying to this old post! It looks like your question got buried! An associate can be FINE. I'd look at the overall picture. How much VT are they doing? Do they have the level of experience to handle the level of problem you have? Our practice has multiple docs, one of whom is a Fellow with COVD. The others are associates. We got perfectly fine care. If they have someone coming in who has extreme problems (prior surgeries, problems going way beyond simple convergence/tracking/depth perception issues, unusual problems) those people are going to the Fellow. But sure an associate can do it! They're just going to vary as to quality and experience, as with any other doc. Look for feedback from people who have used them. Look at online and in person reviews. Visit their office and see their therapy room. Try just a regular visit with the doc and ask for a screening before you commit to the full developmental vision eval. See if their therapists are COVD certified. Quote Link to comment Share on other sites More sharing options...
MommyX8 Posted July 26, 2014 Author Share Posted July 26, 2014 Wow! Just popping on here. I use a COVD fellow. When I looked for a VT, I did use the COVD list. Then I searched my insurance database to find an in-network provider. Once I found one, I applied for the gap exception so that my out of network doc would be covered. There have been a few changes in my insurance protocol. At first, they reimbursed us in full and I only needed to take to National Intake once per year for approval. It has now changed to my submitting claims once I have the therapy appointment and 90-day National Intake approval windows. So this takes a bit more work on my end, but still worth it. I currently have one who graduated, one who is about to graduate, and 3 others (including myself) currently in VT. Anyone who has depth perception is also on a home-based computer program (so they don't have to do that part IN therapy.) I just had an end of unit visit with the doctor. My depth perception is beginning to come in, my eye is not turning off hardly ever now and my eyes are fusing much better. When I walked in the door, I could barely track well enough to read the second line on the eye chart. Yesterday I read the bottom line with no problem whatsoever. 1 Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted July 28, 2014 Share Posted July 28, 2014 Wow! Just popping on here. I use a COVD fellow. When I looked for a VT, I did use the COVD list. Then I searched my insurance database to find an in-network provider. Once I found one, I applied for the gap exception so that my out of network doc would be covered. There have been a few changes in my insurance protocol. At first, they reimbursed us in full and I only needed to take to National Intake once per year for approval. It has now changed to my submitting claims once I have the therapy appointment and 90-day National Intake approval windows. So this takes a bit more work on my end, but still worth it. I currently have one who graduated, one who is about to graduate, and 3 others (including myself) currently in VT. Anyone who has depth perception is also on a home-based computer program (so they don't have to do that part IN therapy.) I just had an end of unit visit with the doctor. My depth perception is beginning to come in, my eye is not turning off hardly ever now and my eyes are fusing much better. When I walked in the door, I could barely track well enough to read the second line on the eye chart. Yesterday I read the bottom line with no problem whatsoever. MommyX8, you rock! :hurray: Quote Link to comment Share on other sites More sharing options...
Guest cpoix Posted December 3, 2015 Share Posted December 3, 2015 We are looking into a healthcare plan that will cover vision therapy for convergence insufficiency for 2016. Has anybody been able to identify a special plan? Quote Link to comment Share on other sites More sharing options...
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