Re: Insurnance question and 's law

[Guest guest]

Exactly! I just want to add that not only does it depend on in which

state you live in ( all states have different Mental Health Parity

Laws) but also on the kind of insurance (HMO or PPO or whatever your

child has). In our case there is the " Utilization Management " who

apparently makes decisions. So it is important to find out the one who

gives you the information how to start the process to get " more " . In

our case the psychologist also has to get involved - it is not enough

that they have all the claims and us calling and writing letters.

sabine

>

> In a message dated 1/2/2007 9:54:44 P.M. Eastern Standard Time,

> autumn71A@... writes:

>

> >>anyway - they said they rarely change it or extend visits etc but

it's

> >>worth writing a letter so I did - it's factual and a bit

threatening

> >>dh thinks it's too threatening - should I get nasty so soon???

>

>

>

> Good for you!! You're making progress! In response to what the

supervisor

> said to you, " ...they rarely change it or extend visits.... " I had

to laugh

> at that -- my husband would have instantly piped up and replied,

" OH, so then

> you DO make exceptions... GOOD " He would see that as a foot in the

door -

> you've already gotten them to admit that it IS possible to get

something more.

> Now you have to see exactly *how much* more they will give....

then push

> just a LITTLE bit harder for a little more. Every time you're

told " there's

> nothing I can do to help you " .... then ask for someone who can.

There's

> almost always someone else.

>

> LT

>

>

>

[Guest guest]

Hi Eileen,

Thanks for the info on the new law - I did not know about it since

(thank goodness) we haven't needed therapy in a few months. I know

Dr. Wagner must be thrilled, she has always said it needed to be that way.

Not having seen your letter, I can't say if you are being too

threatening, but I'm thinking it's fine. Our men tend to stay on the

conservative side of things like this, not wanting to step on any

toes, but I say as long as you are matter-of-fact and knowledgeable

they can't discount you as an overwrought female!

Keep us posted!

nna

NY

>

>

>

>

>

> To update all those who helped me - the fight has begun - we had to

> pay more from dh's paycheck to upgrade and now starting Jan 7th they

> say we'll pay $100 and then they'll pay $32 of the $150 the therapist

> charges for 27 visits and then that's it

> SO....

> I called today asked for a supervisor and was told " I'll try to help

> you and if I can't I'll certainly get one for you " well she was

> helpful to an extent and did ask the supervisor some things for me and

> told me she told the supervisor " this woman is smart and knows what

> she's talking about and is nice " (I took that as a don't mess with her

> plus she's beening nice -for now)LOL

> anyway - they said they rarely change it or extend visits etc but it's

> worth writing a letter so I did - it's factual and a bit threatening

> dh thinks it's too threatening - should I get nasty so soon???

>

> OR pull at their heartstrings?? I did a bit of that too - hey ours are

> pulled at everyday by OCD - I figure let them know a smidge of what

> our lives are like and maybe they'll help more

> plus to any NY people

> Gov pataki signed Tomothy's law 12/22- so that mental illnesses should

> be covered as physical ones are - INS said they've heard of no changes

> yet - he was a boy who committed suicide after not getting proper

> help - his father has been pushing for this - what a great thing he's

> doing in his memory :-)

> thanks and I'll keep you posted

> any other help would be great

> PS I have the power of knowledge from here to fight this- I couldn't

> do this alone!!! THANKS

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> Quoting sabcla15 <sabcla15@...>:

>

> > Hey, that was me,

> > and our situation is still not good.

> > Because we have a PPO they say it is our problem. We are seeing the

> > specialist who is really great and we pay 20 % , we have only 20

> > visits per year ( that is for her and the shrink together). So far I

> > haven't gotten any kind of billing statment from the insurance

company.

> >

> > Did you get a pre-approval? Some insurances require that , in that

> > case your primary has to write something ( it is necessary that my

> > patient xxx is being treated by xxxx because of xxx otherwise the

> > condition can get worse and in-patient service might be needed blabla

> > ) usually they know what to write but it depends on the insurance. Do

> > you have a handbook?It really depends on the plan ( HMO,PPO, Network

> > ....)But once you get the statement get it into review. Our insurance

> > is really freaking.

> > After you got settled in you won't need that much office visits

> > anymore , only the start is more intense ( if it is OCD only - that is

> > what I was told ), unfortunately it looks like my dd also has a mood

> > disorder in addition to TS and OCD , so I need a longterm solution for

> > the insurance mess.

> > The next thing is the state you live in. Massachusetts has a law

> > called " Mental Health Parity Law " which makes sure that you get

> > sufficient treatment with certain DSM 4 dx but unfortunately the

> > company has their main seat in NC and the PPO is NC not MA.

> > We also had to upgrade and pay huge out-of-pocket ! I can feel

your pain !

> > I will start working this spring/summer and hope that both doctors

> > accept the other insurance - I need to talk to them about that next

> > time......

> >

> >

> >

> >

>

[Guest guest]

I will keep your dh's thoughts in mind - that is so true - anything to

say back to them helps!

thanks

eileen

Quoting jtlt@...:

>

> In a message dated 1/2/2007 9:54:44 P.M. Eastern Standard Time,

> autumn71A@... writes:

>

>>> anyway - they said they rarely change it or extend visits etc but it's

>>> worth writing a letter so I did - it's factual and a bit threatening

>>> dh thinks it's too threatening - should I get nasty so soon???

>

>

>

> Good for you!! You're making progress! In response to what the supervisor

> said to you, " ...they rarely change it or extend visits.... " I had to laugh

> at that -- my husband would have instantly piped up and replied,

> " OH, so then

> you DO make exceptions... GOOD " He would see that as a foot in the door -

> you've already gotten them to admit that it IS possible to get

> something more.

> Now you have to see exactly *how much* more they will give.... then push

> just a LITTLE bit harder for a little more. Every time you're

> told " there's

> nothing I can do to help you " .... then ask for someone who can. There's

> almost always someone else.

>

> LT

>

>

>