Wednesday, January 5, 2011

Certain values of Easy Street

Six months ago when Nea turned 6, I called Blue Cross Blue Shield. I knew that insurance companies often use a little BS move, in which they stop covering speech therapy at that age, claiming that apraxia is a developmental delay. Which it is NOT. More here. They said everything was fine then. Great, I said to myself.

Then we made a mistake. In my 2010 health insurance plan, BCBS covered speech therapy up to $2000 per year. We were going to be over that by just a little bit. (Should have just coughed up the difference. Who knew? Hindsight.) So our SLP wrote a letter of medical necessity (it's a thing of beauty with lots of big words), included a bunch of medical records, and BCBS denied it. Which, it turns out, means that they were denying any ST for Nea forever and ever, amen. Not. Cool. I got the news a day or two before Christmas, and frankly, I was in no mood to deal with it. I called BCBS once before the end of the year and did a little half-hearted protesty thing, but you gotta be in the mood, y'know?

So I called yesterday. Forty minutes later, our file was going for re-review. The nice lady said, "We'll call you within 30 days with the results." I rolled my eyes and took notes in my binder. At 3:00 THAT SAME DAY I got a call back from her. It wasn't overturned, but she gave me the key phrases we should use in the next letter. Apparently our SLP didn't call it verbal apraxia in her session notes, and didn't mention specifically that Nea's gap between receptive and expressive language is huge. Whatever. I'm not worried about it at this point. We have to jump through a couple hoops, and we'll be back on Easy Street. For values of Easy Street that include having a 6.5 year old who can't pronounce her last name.

1 comment:

arlopop said...

God, do I hate that shit!!!

I just hate it.