Tuesday, February 24, 2009


I am annoyed.

With insurance.

An ongoing headache for me but today I am extra annoyed.

Insurance. We have always had insurance. I have never really given it much thought. I go to the doctor hand over my card and copay then I am on my way. That is until Brayden. I spend more time on the phone and online trying to understand and make sure that Brayden is covered. Since the time that Brayden was born Jeremy’s office has changed insurance programs several times. Ugh! Every time it is difficult to switch all of Brayden’s things over. A couple of times that switching brought me to tears. The mention of switching insurance makes my stomach in knots.

Last year we were on one program. All seemed to be going well until it came time for Brayden’s therapies. The insurance company said that each insured gets 90 days of physical/occupational therapy. That is therapy has to happen within 90 days…three months. Not 90 days of therapy. His therapy had to happen within 90 days, start to finish. Brayden obviously needs more than 3 months of therapy. We argued that point. Got a doctor’s note/prescription for the needed therapy, thought we were covered. Several months later the insurance company is saying that we were denied the therapy that happened outside those three months! Back to discussing/arguing with the insurance company over something that happened last spring.

Now we are on a HSA insurance plan. Some doctors ask for copays, some do not. I don’t understand. We have reached our limit only a couple of months on the plan. After some discussion with the insurance company last night, I realized that Brayden can have up to $2000 of physical/occupational therapy. Umm…sounds good at the start but we are half way through that limit and it is only February.

So what do we do? Brayden needs therapy. Do we deny him services because insurance does not cover? We will argue for more but it is hard. The insurance company needs some serious convincing. We cannot pay for therapy out of pocket…it is way too costly. Brayden has other expenses that insurance does not cover. Do we cut back in therapy? I was hoping to add feeding therapy back into the mix but that might not be possible.

Who knows what the insurance companies will tell us. I have spent too much time with them on the phone today.

I am working on getting letters of medical necessity to appeal.

Ugh, insurance. It is great when it works and a pain when it does not.

I am annoyed.


Unknown said...

Is there an ECI (early childhood Intervention) program nearby? This is how Regan got therapy for he first three years and it was either state or nationally funded ( I am not sure which). It was really nice and home-based. Her therapists came weekly on schedule, and it worked very well until she was ready for school. We also use a free hospital through the masons ( Scottish Rites Children's Hospital)....Our Insurance company treats us really well because we are not tapping them constantly to pay for things.

Shannon said...

I feel your frustration, Carrie. I am so sorry for all of the additional stress insurance companies cause.

Leah said...

I too have been brought to tears several times by insurance issues. Mainly at the pharmacy. Today will be the first time that Wyatt's medication will actually be covered.
Wyatt qualified for Medicaid and so many of the services we use, equipment, early intervention therapies, his therapeutic daycare and hospital fees are covered. I'm sure it differs state to state, and I'm sure you knew that, but I thought i'd pass it on...love to you all.

Keri said...

My heart goes out to you. I understand the annoyance and frustration completely from experience. If you haven't already, as Christine mentioned, check into Head Start or Early On services. This program does vary from state to state, but there may be a program in VA that also helps assist with what your insurance doesn't cover. I kinda browsed the internet a bit and will send you a link. Just in case you haven't seen it yet.

Leanna said...

Let me tell you...they frustrate ME too and..I am a claims processor for an insurance company. It is VERY frustrating! Even I have to find the right hoops to jump through...

And, I am currently trying to fight the endless battle of trying to get a Medicaid supplement (to my insurance) for the deductible, coinsurance, copays.

I hope you find the help you need and keep fighting!