Guest guest Posted January 1, 2002 Report Share Posted January 1, 2002 Have you tried writing to the Benefits administrator of your husband's company? Sometimes getting these people involved helps. Also someone else wrote about going to the State Insurance fund. Can you re-appeal based on this information. You are right 2.5 hrs to drive is ludicrous! Good luck denise > We have appealed 2x withour insurance company to get coverage for ST. We finally won the appeal--they stated that for Apraxia, it was medically neccessary. All was great. Then they came back and said they wouldn't pay because our SLP is out of network. BUT when asked who was in the network, they just said this Speech and HEaring Clinic in Indianapolis (I live in IN). Indianapolis is 2.5 hours away! I know other states have a law about if the provider is more than so many miles a way from you they have to allow you to see another one that is closer. Our lawyer cannot find any law like this for IN. I think this is ridiculous. They can't expect us to drive to Indy for ST and the clinic they are talking about probably doesn't even offer ST!! My husband seems to be wimping out on me doing exactly want the insurance company wants--giving up. I wont do that. Right now I am working 2.5 days a week against my wishes to pay for this therapy. We live in an area with a school system that is just ridiculous and refuses to give more than 2 30 minute ST sessions a week. I am also afraid my son is going to need more therapy because we seem to be going towards an autism or PDD-NOS diagnosis. I have spent hours on the phone with gov't agencies. No one can help. We make too much money for most funding but yet we are so strapped! It makes no sense to me. > > Can anyone help?? > > Zwick > bearcat@u... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 1, 2002 Report Share Posted January 1, 2002 , I just thought of something. As you know I live near you and my husband has the same insurance as your husband. I just realized that I take my daughter to the hospital to get her ST. So, when I am billed, I am billed by the hospital, not by an individual Speeth Therapist. I looked in my husbands book of approved providers, and I saw that your local hospital is also listed. Do they have a Speech Therapist that works in there as mine does? It was just a thought, but I thought that you could check it out. If that hospital doesn't perhaps another one near you does. I could also ask my daughters ST if she knows of anyone near you, that is covered by your insurance if you would like. Your friend, S. Surfus >From: " Zwick " <bearcat@...> >Reply- >< > >Subject: [ ] Insurance question?? >Date: Tue, 1 Jan 2002 10:20:44 -0600 > >We have appealed 2x withour insurance company to get coverage for ST. We >finally won the appeal--they stated that for Apraxia, it was medically >neccessary. All was great. Then they came back and said they wouldn't pay >because our SLP is out of network. BUT when asked who was in the network, >they just said this Speech and HEaring Clinic in Indianapolis (I live in >IN). Indianapolis is 2.5 hours away! I know other states have a law about >if the provider is more than so many miles a way from you they have to >allow you to see another one that is closer. Our lawyer cannot find any >law like this for IN. I think this is ridiculous. They can't expect us to >drive to Indy for ST and the clinic they are talking about probably doesn't >even offer ST!! My husband seems to be wimping out on me doing exactly >want the insurance company wants--giving up. I wont do that. Right now I >am working 2.5 days a week against my wishes to pay for this therapy. We >live in an area with a school system that is just ridiculous and refuses to >give more than 2 30 minute ST sessions a week. I am also afraid my son is >going to need more therapy because we seem to be going towards an autism or >PDD-NOS diagnosis. I have spent hours on the phone with gov't agencies. >No one can help. We make too much money for most funding but yet we are so >strapped! It makes no sense to me. > >Can anyone help?? > > Zwick >bearcat@... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 3, 2002 Report Share Posted January 3, 2002 We've had lots of problems with insurance. We've had problems with the school district. I finally found out about the ish Rite Foundation having a speech and language clinic in our area (San ). They provide free speech therapy for 18 months regardless of income. The waiting list is long, but it has been a great program. If you have a clinic in your area, you might want to check them out. Suzi > We have appealed 2x withour insurance company to get coverage for ST. We finally won the appeal--they stated that for Apraxia, it was medically neccessary. All was great. Then they came back and said they wouldn't pay because our SLP is out of network. BUT when asked who was in the network, they just said this Speech and HEaring Clinic in Indianapolis (I live in IN). Indianapolis is 2.5 hours away! I know other states have a law about if the provider is more than so many miles a way from you they have to allow you to see another one that is closer. Our lawyer cannot find any law like this for IN. I think this is ridiculous. They can't expect us to drive to Indy for ST and the clinic they are talking about probably doesn't even offer ST!! My husband seems to be wimping out on me doing exactly want the insurance company wants--giving up. I wont do that. Right now I am working 2.5 days a week against my wishes to pay for this therapy. We live in an area with a school system that is just ridiculous and refuses to give more than 2 30 minute ST sessions a week. I am also afraid my son is going to need more therapy because we seem to be going towards an autism or PDD-NOS diagnosis. I have spent hours on the phone with gov't agencies. No one can help. We make too much money for most funding but yet we are so strapped! It makes no sense to me. > > Can anyone help?? > > Zwick > bearcat@u... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2002 Report Share Posted January 4, 2002 The ish Rite Foundation is available in other areas and also offers " scholarships " to older kids, which mean very reduced therapy rates for some. [ ] Re: Insurance question?? We've had lots of problems with insurance. We've had problems with the school district. I finally found out about the ish Rite Foundation having a speech and language clinic in our area (San ). They provide free speech therapy for 18 months regardless of income. The waiting list is long, but it has been a great program. If you have a clinic in your area, you might want to check them out. Suzi > We have appealed 2x withour insurance company to get coverage for ST. We finally won the appeal--they stated that for Apraxia, it was medically neccessary. All was great. Then they came back and said they wouldn't pay because our SLP is out of network. BUT when asked who was in the network, they just said this Speech and HEaring Clinic in Indianapolis (I live in IN). Indianapolis is 2.5 hours away! I know other states have a law about if the provider is more than so many miles a way from you they have to allow you to see another one that is closer. Our lawyer cannot find any law like this for IN. I think this is ridiculous. They can't expect us to drive to Indy for ST and the clinic they are talking about probably doesn't even offer ST!! My husband seems to be wimping out on me doing exactly want the insurance company wants--giving up. I wont do that. Right now I am working 2.5 days a week against my wishes to pay for this therapy. We live in an area with a school system that is just ridiculous and refuses to give more than 2 30 minute ST sessions a week. I am also afraid my son is going to need more therapy because we seem to be going towards an autism or PDD-NOS diagnosis. I have spent hours on the phone with gov't agencies. No one can help. We make too much money for most funding but yet we are so strapped! It makes no sense to me. > > Can anyone help?? > > Zwick > bearcat@u... > > > Quote Link to comment Share on other sites More sharing options...
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