jgmklmhem
DIS Veteran
- Joined
- Dec 8, 2003
- Messages
- 2,053
Looking for advice on how to handle this situation further. Our second DD age 3 needs speech therapy stemming from her multiple birth defects including a cleft palate. She is currently seeing the speech therapist at our elementary school once a week. My wife and I thought it might do her good to see a therapist as well. She had been going to a group therapy place but they age you out at 3.
My wife gets a recommendation from DD's craniofacial team. We call and specifically set up an evaluation appointment for DD. Our insurance doesn't cover the therapy until our deductable is met but they do cover evaluations with a 25$ co-pay. We made sure we set up an evaluation (being the first appointment what else could it really be). We called and confirmed this with both the therapists office and the insurance company. Both say only 25$
Well DW and DD go and the appointment lasts about an hour. A few weeks later we get a bill for the whole amount $300. Our insurance statement comes and still we owe the whole bill. At this point I am confused so I call the insurance company first and they say the bill was coded for therapy and not an evaluation. We call the therapist office and they say that since the visit lasted more than 30minutes (their so-called standard evaluation period) then the visit must be coded for therapy. DW nor I was ever told that after 30min we get billed differently. There was no attempt to stop the "evaluation" after said 30minutes (meaning my wife didn't extend the visit voluntarily...she just sat back and watched for the most part while the therapist talked to our DD).
Am I wrong to be a bit miffed about this situation? The billing lady today told us that we should have just known to cut the visit at 30minutes. How we were supposed to know this information is beyond me. No paperwork we have been given has ever stated this supposedly "well known" fact. I am looking for what others might think the next step should be in this saga.
Thanks!
My wife gets a recommendation from DD's craniofacial team. We call and specifically set up an evaluation appointment for DD. Our insurance doesn't cover the therapy until our deductable is met but they do cover evaluations with a 25$ co-pay. We made sure we set up an evaluation (being the first appointment what else could it really be). We called and confirmed this with both the therapists office and the insurance company. Both say only 25$
Well DW and DD go and the appointment lasts about an hour. A few weeks later we get a bill for the whole amount $300. Our insurance statement comes and still we owe the whole bill. At this point I am confused so I call the insurance company first and they say the bill was coded for therapy and not an evaluation. We call the therapist office and they say that since the visit lasted more than 30minutes (their so-called standard evaluation period) then the visit must be coded for therapy. DW nor I was ever told that after 30min we get billed differently. There was no attempt to stop the "evaluation" after said 30minutes (meaning my wife didn't extend the visit voluntarily...she just sat back and watched for the most part while the therapist talked to our DD).
Am I wrong to be a bit miffed about this situation? The billing lady today told us that we should have just known to cut the visit at 30minutes. How we were supposed to know this information is beyond me. No paperwork we have been given has ever stated this supposedly "well known" fact. I am looking for what others might think the next step should be in this saga.
Thanks!
Then try to explain the situation (just what you told us is great) objectively and without sounding angry or upset, and when you're done ask her how she suggests the problem can be resolved. 
