Friday, July 22, 2011

Part 2: Our insurance saga - Winning!

My last insurance update was here.

Several months ago I heard from Blue Cross Blue Shield. In a chirpy voice, the nice lady told me that they were not only going to stop paying for speech, they had changed their minds and were TAKING BACK all the money they paid our SLP this calendar year. Under the very weak argument that they do not cover developmental delays after age 6. Nea is 7 now. She does not have a developmental delay. She has apraxia.

I'll be honest. I was a little pissed off.

So we lawyered up. Which was a great decision. Also, turns out ASHA* (American Speech-Language-Hearing Association) has a very helpful form letter that argues persuasively (using that insurance-speak language that the insurance companies love) that apraxia is not a developmental delay. Please contact them if you need help fighting your insurance company.

Here's the money shot from their letter:

Verbal apraxia is not a developmental delay and a child will not outgrow this disorder. It is not an educational issue, but rather an issue of health and normal physiological function. Developmental delay describes a slower than normal rate of development, but verbal apraxia is a disorder.

The lawyer (who, I'll be honest, is ruining my deep suspicion and disregard for the profession) recommended we get nice, fresh letters of medical necessity from our SLP and pediatrician. These letters said the same thing as the letters we had previously submitted, but they were, you know, new. Plus she has fancy letters behind her name when she signs official documents. People respect that.

And then the clouds parted. The sun shone.

And therefore, ta da. BCBS is covering our ST again. With no visit maximum for the calendar year! (Let's go every day!) I'd frankly feel even more excited if I didn't think we'll have to go through it all again next year. Still, a victory for now. I'll take it.

Thanks to some help from my friends on Facebook (shout out to Steve and Lex! Smoochies!), we have a rewritten I Fought the Law by The Clash (from the point of view of BCBS)

Denying claims in the hot sun,
I fought Bluestem and...she won.
I fought the completely rational and justified MamaBear and...she won.

*Next time perhaps I'll share my thoughts on the American Saddlebred Horse Association and the American School Health Association.

C'mon! Everybody sing!

1 comment:

Anonymous said...

Twice a day!
Three times on Fridays!!