Jean in Newcastle Posted October 25, 2013 Share Posted October 25, 2013 I have my insurance policy out. It says that it will not pay for vision therapy. So that's clear enough. Then it says that it will not pay for mental health treatment for certain conditions. Under this paragraph it says "this would include, but is not limited to, such issues as occupational or academic problems". So this means no learning disability testing, right? Quote Link to comment Share on other sites More sharing options...
Heathermomster Posted October 25, 2013 Share Posted October 25, 2013 Call insurance and ask. When DS was NP tested the first time, the mental health portion of insurance covered 60% of the testing because an ADHD assessment was included. Quote Link to comment Share on other sites More sharing options...
SKL Posted October 25, 2013 Share Posted October 25, 2013 Even if they will not cover all of it, they might cover some of it, such as the diagnostic visit(s) and the glasses (if any). Ask the doctor / therapist to break out the bill into categories based on medical coding (hopefully they will know what that means better than I can explain it). Every little bit helps. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted October 25, 2013 Author Share Posted October 25, 2013 I've called the insurance. A very helpful woman is researching everything and she will call me back with a detailed list of all the information I need to know. She did tell me that the neuropsych that has been highly recommended and that I want to do the testing is out-of-network. Quote Link to comment Share on other sites More sharing options...
FairProspects Posted October 26, 2013 Share Posted October 26, 2013 Jean - I don't know if you have Regence, but since they are a huge carrier in our general area I thought it might be worth mentioning that they have just lost a lawsuit regarding their denials of neurodevelopmental claims and they have recently been required by the Insurance Commissioner to begin paying out on these types of claims. If your insurance is Regence, I think it would be worth some further investigation or appeals to see if they have updated their policies. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted October 26, 2013 Author Share Posted October 26, 2013 Jean - I don't know if you have Regence, but since they are a huge carrier in our general area I thought it might be worth mentioning that they have just lost a lawsuit regarding their denials of neurodevelopmental claims and they have recently been required by the Insurance Commissioner to begin paying out on these types of claims. If your insurance is Regence, I think it would be worth some further investigation or appeals to see if they have updated their policies. Yes, it is Regence. They still have not gotten back to me. But then it is the weekend now so I don't expect a call back now until Monday. Quote Link to comment Share on other sites More sharing options...
OneStepAtATime Posted October 31, 2013 Share Posted October 31, 2013 Any luck yet? Quote Link to comment Share on other sites More sharing options...
GoVanGogh Posted October 31, 2013 Share Posted October 31, 2013 I mentioned insurance in the 'how to pay' thread. We had an epic battle with our insurance company to cover therapy, even though we have a medical dx that implies the child is going to have developmental delays and our state specifically states that insurance companies must cover certain therapies for developmental delays. We started therapy, knowing that they weren't covering. In the meantime, we started filing appeals. Each appeal takes 6-8 weeks. We lost three appeals, the most you can appeal before taking it to the state attorney general. After we lost our final shot at appealing, we called up insurance and said, "Really? You want us to take it to the state attorney general?" We were notified the next day that we won our appeal and they would reimburse us for all the claims denied. I share that because - There are laws about what insurance companies must pay. It does depend on the dx. But - always fight and appeal. The key is to wear them out. Mention the word 'lawyer' if you have to. Always ask to speak to someone above the person you are talking to. Write down names, titles and date/time you spoke with them. Quote Link to comment Share on other sites More sharing options...
FairProspects Posted October 31, 2013 Share Posted October 31, 2013 I agree with the above. We had Regence and went through 3 internal appeals over OT, lost all 3, went to an outside appeal which was the last step before the Insurance Commissioner and/or lawsuit. We won on that round and Regence did have to pay. Appeal, appeal, appeal and fight for it especially given what has been happening recently with this insurance company. Quote Link to comment Share on other sites More sharing options...
Julie of KY Posted November 1, 2013 Share Posted November 1, 2013 If you have partial mental health coverage, then testing may be covered under the umbrella of testing for ADHD, etc. along with learning disabilities. Quote Link to comment Share on other sites More sharing options...
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