Frustrated and in tears....

[letfuller]

I am now doing the happy dance. We were referred to a new neuropsychologist in Boise AND have been given insurance authorization already. YEAH! It is closer to home and an earlier testing date. Good news!




After 5 months of waiting to get an appointment to have DD11 neuropsycholgogically tested (because of Dr. recommend); our insurance company is NOT paying due to " Neuropsychological testing is covered when a neurological disorder is present AND a diagnosis would result in specific treatment."

Does a Complete Agenesis of the Brain (connective bridge for rt and lft brain communication), enlarge ventricles and a mid-line shift constitute a neurological disorder?

As this a new diagnosis for us, we are trying to find the best ways to help our daughter. If we still keep our appointment (300 miles from home) it will still cost us $800.00 to have her evaluated. We just don't have that type of money at this time and the hospital won't take any other partial payments.

So, now what do we do? Her appointment is Jan 16...

I just want to curl up in a fetal ball and weep.





I hate insurance companies sometimes.

 

[alizesmom]

Sending hugs. Remember to appeal. I think the refuse things initially just to see if we'll go away. Karen

 

[Luv Bunnies]

Yes, insurance companies will always try not to pay. It sounds like you already have a diagnosis that would justify further testing. Can you get your original doctor to write a letter to the insurance company explaining why the specialist is needed, if that wasn't already done?

Hope you get things straightened out. It can be so frustrating to deal with these things!

 

[Tiggerish]

DO NOT accept the insurance company's position without protest. If possible, ask your requesting doctor to write a note stating the exam is for an existing neurological condition and it is anticipated testing will result in specific treatment, then submit that with the appeal. If your current care is through a hospital you may be able to get the hospital social worker to help you with an appeal of the insurance company's decision.

Also call the hospital or facility where the test is supposed to be done and ask about "charity" care. Many have programs to help but you have to ask.

 

[sdarwkcabemanmy]

Appeal appeal appeal.

Ins. companies are so dumb sometimes. Right now we're trying to convince ours that allowing me to get my tubes tied would be a good thing. I don't plan on having any more children and it would just be cheaper in the long run to have my tubes tied.

 

[bookwormde]

When at all possible insurance companies will say no the first time to see if you are “serious”. As everyone else has said start the appeal process, but do not stop there, call your states insurance commissioner, some state even have an advocacy service. When it comes to denying diagnostic services and treatments they generally have a very dim view of insurance company “silliness” because they know without proper treatment a large percentage of these children end up needed some type of “public support”.

The insurance company has no idea what the final diagnosis if any will be from the evaluation so they have no way to determine if there are treatments.

Some of the problem may be in the doctor’s request if he was to specific about what he expected instead of getting a broader evaluation to determine that potential cause of symptoms and manifestations.

Keep fighting it is worth it.

bookwormde

 

[mechurchlady]

Took 5 months on one accident that was a minor fender bender. The last accident I probably blacked out and was questioned by an officer that took everything down wrong like that I was driving 2 feet behind the guy in front of me at 60mph on a curve. My car was scrapped and I bought her back. She is a bucket of rust but I love her and she saved my life once before the accident.

DO NOT EVER EVER EVER GIVE INTO INSURANCE COMPANIES.
They will do everything they can to keep their dividends high and avoid paying out. They will not tell you secrets on what you can get or anything either. Fight and check out if you can get a payment plan. If not I will send you $20. the kid needs that testing and I ABHOR insurance companies and have had it with their nasty ways.

 

[letfuller]

Thanks everyone for your kind words. We will appeal, but I really wanted to get her tested next month. Now it is just up to us to locate $800 big ones for the down payment.

~Linda

 

[mechurchlady]

Is there any hope of them taking partial payments? My offer of $20 still stands if the kid needs it. I like helping kids out as I have none except my mother, sigh.

 

[letfuller]

Thank you for the offer of $$, but we will reschedule the appointment and BATTLE the insurance company. I am pretty fierce when I need to be and we will come on the winning end of this.

Emily will get the testing, just a bit later than we were hoping for. It is my hope that since we are now in the system, they will continue to keep us in the scheduling lineup. Who knows, there may be a miracle and they may say to just come with no money down when I call to reschedule.

Thanks again for all of your kinds words and thoughts.

~Linda

 

[zumbergc]

does your insurance company have a patient coordinator, to help patients out that have difficult medical issues. my parents were assigned one when my mom had cancer. As she was repeatadly hassled to get her nasia meds, which she had, and then every time the doc wrote a new script it took forever for them to approve the coverage.

It really helped things as more and different test were ordered, and different meds were ordered. They would call the advocate and then she worked the "magic" to get things approved and done.

They might be called a patient advocate.

i offer you a big hug, and keep on fighting!!

 

[jennb529]

You may call your insurance and insist on a "peer to peer" call. This is where one of the docs that helps approve claims for the insurance company actually speaks with the doctor that you want to see and your doctor would therefore get a chance to explain why the testing is necessary. I have a master's in psych and work for a neuropsychologist and he has to do this all the time.

Sometimes insurance companies have a stipulation that they will pay for the testing if the results fall under a medical diagnosis, but not a mental diagnosis, but your case would definately be medical. As others have said, APPEAL. This type of testing is still not widely understood by the general public, but is VERY helpful.

 

[letfuller]

I edited my OP that we now have a new appointment AND insurance approval. It is a good thing!

 

[bookwormde]

Congratulations it is nice to be “moving forward”

bookwormde