Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 and 784.69 are legit to be paid by the insurance. Have your provider reissue the receipts with the above codes. HELP HELP HELP!!! > Our family is in desperate need of some really good legal advise. > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > Verbal Apraxia of Speech. To make a long story short, ALL of our > medical claims for speech therapy were denied for 2005. Basically > when we went to pre-certify for therapy they said it was a covered > expense, then in April (after 3 months of therapy) they sent a > letter requesting " more information " . We continued therapy, in > NOVEMBER they said the therapy was for developmental delay. We are > stuck at a crossroads because we have appealed and still be denied. > There are so many more details to all this, but i dare not bore all > of you. What we are wondering is if anyone has the name of a good > attorney in the houston area that we could consult with about the > WHOLE issue. (The service provider acted negligently as well--but i > won't bore you) Any names and information you could give us is > greatly appreciated. As of March, we had to stop therapy and now > have a medical bill amounting to over $10,000. What really gets my > goat is that if i had set out knowing i would have that amount of > money to pay i would have chosen to put it towards some really good > ABA and found someone else to do the speech on a " private " basis or > included the speech as part of the ABA. > > Thanks in advance for your help!! > > Tami Eichenberger > Mother of and Spencer > > > > > > Texas Autism Advocacy > www.TexasAutismAdvocacy.org > > Texas Disability Network > Calendar of Events > www.TexasAutismAdvocacy.org > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 What about a complaint to the Texas Department of Insurance? Holler if you need links to the online process. Tonya Re: HELP HELP HELP!!! Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 What about a complaint to the Texas Department of Insurance? Holler if you need links to the online process. Tonya Re: HELP HELP HELP!!! Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Ah, that would be fraud. I would suggest that you contact your state rep's and senator's offices. Requests from a legislator to help you look into this. Nothing like an inquiry from the Office of Insurance to make companies pay up. I had to use this route when I was make other types of claims the company had balked on. S. Re: HELP HELP HELP!!! Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Ah, that would be fraud. I would suggest that you contact your state rep's and senator's offices. Requests from a legislator to help you look into this. Nothing like an inquiry from the Office of Insurance to make companies pay up. I had to use this route when I was make other types of claims the company had balked on. S. Re: HELP HELP HELP!!! Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Good to hear that you got results that route. When I filed a complaint with TDI against United Healthcare, I got a letter stating that they (TDI) have no authority to compel United to do anything. Singleton wrote: Ah, that would be fraud. I would suggest that you contact your state rep's and senator's offices. Requests from a legislator to help you look into this. Nothing like an inquiry from the Office of Insurance to make companies pay up. I had to use this route when I was make other types of claims the company had balked on. S. Re: HELP HELP HELP!!! Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Good to hear that you got results that route. When I filed a complaint with TDI against United Healthcare, I got a letter stating that they (TDI) have no authority to compel United to do anything. Singleton wrote: Ah, that would be fraud. I would suggest that you contact your state rep's and senator's offices. Requests from a legislator to help you look into this. Nothing like an inquiry from the Office of Insurance to make companies pay up. I had to use this route when I was make other types of claims the company had balked on. S. Re: HELP HELP HELP!!! Unfortunately those are the codes that we used in the first place. They are, of course, saying those are developmental as well. It's extra frustrating because the plan does provide for Speech Therapy, but when you look at the speech codes they are ALL developmental in some way. I guess that's how they get away with not paying. Seems a little deceptive to me. Say you cover speech to get the consumer to switch to that policy, but then when it comes time to pay, there isn't a single code that will cover it. Hmmmm, interesting don't you think?? > > if your son has a diagnosed with apraxia, using the diagnostic codes 784.5 > and 784.69 are legit to be paid by the insurance. Have your provider > reissue the receipts with the above codes. > > > HELP HELP HELP!!! > > > > Our family is in desperate need of some really good legal advise. > > We have a 5 yr old son (Spencer) who is diagnosed with Autism and > > Verbal Apraxia of Speech. To make a long story short, ALL of our > > medical claims for speech therapy were denied for 2005. Basically > > when we went to pre-certify for therapy they said it was a covered > > expense, then in April (after 3 months of therapy) they sent a > > letter requesting " more information " . We continued therapy, in > > NOVEMBER they said the therapy was for developmental delay. We are > > stuck at a crossroads because we have appealed and still be denied. > > There are so many more details to all this, but i dare not bore all > > of you. What we are wondering is if anyone has the name of a good > > attorney in the houston area that we could consult with about the > > WHOLE issue. (The service provider acted negligently as well-- but i > > won't bore you) Any names and information you could give us is > > greatly appreciated. As of March, we had to stop therapy and now > > have a medical bill amounting to over $10,000. What really gets my > > goat is that if i had set out knowing i would have that amount of > > money to pay i would have chosen to put it towards some really good > > ABA and found someone else to do the speech on a " private " basis or > > included the speech as part of the ABA. > > > > Thanks in advance for your help!! > > > > Tami Eichenberger > > Mother of and Spencer > > > > > > > > > > > > Texas Autism Advocacy > > www.TexasAutismAdvocacy.org > > > > Texas Disability Network > > Calendar of Events > > www.TexasAutismAdvocacy.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 Tami, Interesting on reading this info. In my experience, insurance companies are more likely to pay for specific services for a clearly defined speech and language problem. The claim should be a description of the specific speech,language, or hearing problems a child experiences. So your saying the insurance denied coverage for speech language therapy, bummer. I hope you do find some information on a different approach. Difficulty with motor planning for speech, once upon a time this is what the speech and language pathologist used when asessing whether developmental apraxia of speech is a problem. Developmental verbal apraxia is the best term to use for insurance forms, same thing, but sounds more medical than speech based. When you appealed it the first time, has a letter of medical necessity for treatment been submitted? Hopefully you run into some luck, this should be reconsider coverage of speech-language pathology services for your child. This treatment is medically necessary to treat the medical condition of verbal apraxia, which is the result of neurological damage. Have you google search under medical necessity for treatment for Speech therapy or Apraxia? This site includes this info which I briefly noticed, there could be more. http://www.apraxia-kids.org/site/apps/nl/content3.asp? c=chKMI0PIIsE & b=788455 & ct=464283 If coverage is denied: If your policy lists speech pathology services as a covered benefit but you were still denied: Call your insurance company to determine the reason for denial. Ask for a copy of the your plan's policy for speech therapy services and an explanation for the denial in writing. Ask the individual what is required from you to turn the denial into an acceptance (precisely what information does the insurance company need?). Write down who (you spoke with), when (time and date), and what (was said) for all telephone calls. Keep all fax confirmations. Write a letter to your insurance company asking them to review the claim again. A written inquiry will more likely result in a written response. The letter should be copied to your employer's human resources officer. Include information about apraxia and its treatment. Feel free to quote the Apraxia-Kids website. Please return posting with any updates. I am interested on hearing more as this is terrible how many health insurance keep denying services. I use to work at a physical therapy clinic and had to appeal for numerous Worker's comp patients and it did require alot of appealing and majority of the time, ended up getting paid. It has been awhile when I use to work with medical billing and of course with a different cause, medical insurance policies has changed alot too. Wishing you find a loop hole. Irma > > Unfortunately those are the codes that we used in the first place. > They are, of course, saying those are developmental as well. It's > extra frustrating because the plan does provide for Speech Therapy, > but when you look at the speech codes they are ALL developmental in > some way. I guess that's how they get away with not paying. Seems > a little deceptive to me. Say you cover speech to get the consumer > to switch to that policy, but then when it comes time to pay, there > isn't a single code that will cover it. Hmmmm, interesting don't > you think?? Quote Link to comment Share on other sites More sharing options...
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