Guest guest Posted September 10, 2000 Report Share Posted September 10, 2000 , (And ), I don't know where you live or if this will be available to you. When I went to the pharmacy to pick up 's med one month (no drug card) the pharmacist told me about a couple of services that I could check out. One catch for us is that they must be diagnosed with a chronic disease, which we have not been. You contact the Department of Children's Medical Services. The name of the program that she mentioned was TEFRA. This is like a medicaid, but it's only for children with chronic diseases, as I said earlier. The best part about this is that they only use the child's income to determine eligibility. We had some friends who had a daughter that was born with major heart problems and was in the hospital for over 9 of her 11 weeks of life. Her bill ended up being over $600,000 and they didn't have to pay a penny. And they had Blue Cross Blue Shield insurance. So-- this is just something that some of you may want to check into. I meant to send this info earlier when was going through everything with his ins. co. with Skyler, but couldn't find the paper that the pharmacist had given me. It just resurfaced! I hope I have all of this info correct. If you check into any of this and I was wrong, please let me know. in AR imshellrenee@... wrote: > > Hi Everyone, > > Well, in today's mail I received a paper from our insurance company (Trigon) > stating they would no longer cover any PT/OT for Kelsey because we have > already reached our limit, which is $5,000 per year. We reached that amount > in only 3 months, April-June. The insurance only covered 80% anyway, making > it very expensive to begin with, and now if they won't pay there is no way we > can afford it. The month of July was $1434, which as of right now we are > responsible for not to mention August and now into September. (Also not > including all the other doctor bills we have piling up) UGH! I'm so > frustrated! They said the only thing we can do is appeal and have the > doctors send letters and copies of their notes, but they had to do all that > to get it approved in the first place! > > Kelsey's rheumatologist really wants her to continue PT at least 2-3 times > per month, but if insurance isn't going to cover it, how do I get the doctor > to understand we cannot afford nearly $1500 a month for therapy? Even if we > cut back, its too expensive. I hate to sound like I'm putting a price tag on > my child, but honestly the exercises they do with her at therapy I could very > well do with her at home, and we also have access to a heated pool. We've > also looked into financial aid such as medicaid, etc and were told my husband > makes too much money. (I'm still looking for all this money they claim we > have! lol) However I have not applied for SSI or anything, thinking Kelsey > won't qualify. Even before we found out the insurance wasn't going to pay we > were questioning the true need to continue, but I'm not sure how wise it > would be to go against what the doctor recommends. Sorry this turned out to > be so long, but any advice or suggestions???? > > Thanks, > > > For links to websites with JRA info visit: > http://www.geocities.com/Heartland/Village/8414/Links.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2000 Report Share Posted September 11, 2000 if you take kelsey to your county hospital for physical therapy they cannot deny her therapy. you have to meet a billing person, but if you tell them you can only afford to pay a dollar a week they are not allowed to ever ask for more or stop her therapy. _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Share information about yourself, create your own public profile at http://profiles.msn.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2000 Report Share Posted September 11, 2000 appeal this also call the dr and tell him and call the PT to have them write a note stateing the need of the PT Robbin Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2000 Report Share Posted September 11, 2000 Robbin, I have a letter already I'm going to send in tomorrow's mail that the doctor sent me last week. The insurance company just picked up and decided to pay 2 weeks ago, and the doctor had sent me a letter stating Kelsey's need for PT in case they denied it. So 2 weeks after they decide to cover it in the first place, they stop paying, saying we've reached our limit. Who are they to judge what our kids need? They aren't medical professionals, doctors, etc. and I don't see how they get away with doing this to so many people every day. I plan to appeal it, but if I can't get it approved I'm going to talk to the doctor and search for other options. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2000 Report Share Posted September 11, 2000 , Ask the PT and OT if they can teach you the exercises, then you can do them at home. We did that for a year, just checking in with the pros every few weeks. Liz imshellrenee@... wrote: > > > Hi Everyone, > > Well, in today's mail I received a paper from our insurance company (Trigon) > stating they would no longer cover any PT/OT for Kelsey because we have > already reached our limit, which is $5,000 per year. We reached that amount > in only 3 months, April-June. The insurance only covered 80% anyway, making > it very expensive to begin with, and now if they won't pay there is no way we > can afford it. The month of July was $1434, which as of right now we are > responsible for not to mention August and now into September. (Also not > including all the other doctor bills we have piling up) UGH! I'm so > frustrated! They said the only thing we can do is appeal and have the > doctors send letters and copies of their notes, but they had to do all that > to get it approved in the first place! > > Kelsey's rheumatologist really wants her to continue PT at least 2-3 times > per month, but if insurance isn't going to cover it, how do I get the doctor > to understand we cannot afford nearly $1500 a month for therapy? Even if we > cut back, its too expensive. I hate to sound like I'm putting a price tag on > my child, but honestly the exercises they do with her at therapy I could very > well do with her at home, and we also have access to a heated pool. We've > also looked into financial aid such as medicaid, etc and were told my husband > makes too much money. (I'm still looking for all this money they claim we > have! lol) However I have not applied for SSI or anything, thinking Kelsey > won't qualify. Even before we found out the insurance wasn't going to pay we > were questioning the true need to continue, but I'm not sure how wise it > would be to go against what the doctor recommends. Sorry this turned out to > be so long, but any advice or suggestions???? > > Thanks, > > > For links to websites with JRA info visit: > http://www.geocities.com/Heartland/Village/8414/Links.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2000 Report Share Posted September 12, 2000 look into the child health care this is under a plan and really they cant deny call your state health care medicaid dept and ask them they should gve you advice on how to appeal with force the insurance companys THINK they can do kids like this also ask if you would be eligible for their services this would help also i know here we have a childrens hospital that goes on pay scale and also something called peach care which helps kids its a insurance just for kids and its i think 7 dollars a month i should get more info on that but i think its only in georgia clinton has a child health care plan out also call your local arthritis foundation and tell them whats going on they also can guide you let me know if any helps Robbin Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2000 Report Share Posted September 12, 2000 ,' I wish I could give you words of wisdom..maybe someone else here can. But I can tell you that I know our ins. has a limit on Pt & that is why Ashton is not formally going to Pt. What we have done is actually work with the Ped's PT thru the rheumy's office. She gave us various exercises to do at home. Also don't know where you live but what about the Shriners? I know there are paople on this site who go thru them for help.... they may be able to offer some assistance. Prayers are with you all. Kris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2000 Report Share Posted September 13, 2000 I know it is tough to make decisions on sending your young child to school. But there are benefits. Kelsey can go to an ese pre-k class at your public school and get therapy there. I know it will be hard because she is only 3 but it is an option to consider to get her the pt she needs. Just a thought..... Charlene (CHYCHYS Mom) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2000 Report Share Posted September 13, 2000 Charlene, Actually the preschool program here for special needs children is located at my other daughter's elementary school. Its very nice, and we are familiar with everyone and it would help the school get to know Kelsey before she starts Kindergarten. She may go there next fall, we haven't really decided yet if we want to send her there or to the program at our church, only at the church she wouldn't get PT. She will definitely go to preschool of some kind, because she has been home with me since birth and I know she needs it to get ready for Kindergarten. Thanks, Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.