insurance denial.
insurance denial.
My son Patrick (who turns 3 today) has been denied further ot and pt services. I will be appealing this decision and need any help anyone can give. I will be asking Patrick's bpi surgeon to write a letter as well. They stated they denied him because his benefits have been exhausted (Aetna us healthcare). Is there any way around this. Can anyone help. Thanks.
Re: insurance denial.
Do you have medical assistance in NJ ? or the CHIP program? this is how we get around it here in PA...they give us secondary insurance that covers what primary won't.
Here's another idea - could he get this therapy under a different diagnosis? For example - hypotonia? gait issues? talk to your primary doctor and maybe you two can think of a way to go around the 'system'. (however this would be for PT not OT)
Is Patrick getting Early Intervention therapy? If so - can this be 'upped' to counter the lack of the medical model OT ?
there were 3 links posted in ryan's post about insurance..forgot the title...check there, they may be helpful.
Good luck and let us know what direction you take, what works and what didn't.
-francine
Here's another idea - could he get this therapy under a different diagnosis? For example - hypotonia? gait issues? talk to your primary doctor and maybe you two can think of a way to go around the 'system'. (however this would be for PT not OT)
Is Patrick getting Early Intervention therapy? If so - can this be 'upped' to counter the lack of the medical model OT ?
there were 3 links posted in ryan's post about insurance..forgot the title...check there, they may be helpful.
Good luck and let us know what direction you take, what works and what didn't.
-francine
Re: insurance denial.
Beth, are you enrolled in the National Medical Excellence Program? -Tina
Re: insurance denial.
I am on Aetna too and they have denied therapy for my daughter too. One therapist is working with another company to get coverage and come to my house still too. I would definitly fight it! Get the neurologist, the OT, and the PT to write a note. Good luck and keep us informed on how it turns out!
Tracey
Tracey
Re: insurance denial.
After my son had the mod quad last Aug I had to fight for PT and OT through my insurance. It was kinda easy since he just had surgery but they wanted me to travel a bit for it. I sent the insurance co a picture of my son in his SOL splint and some awareness info regarding BP injuries. The insurance co (MPN) said name your facility, whereever you want to go, we will make arrangements with them. I really think the picture did it. I found out the name of the person that makes the decision and sent him directly all the info. Think about it. Maybe something along this lines might help. Good luck. 
