Need help with insurance letter

[Guest guest]

Ok guys and gals, I need your help.

I'm submitting (again) for insurance coverage for speech services.

The last time we submitted, under my old SLP, we were denied because

the problem was deemed developmental, rather than it being from an

illness or trauma (I think they said it needed to be physiological,

or something like that). I just submitted bills from my new SLP and

they've requested the following:

CPT4 procedure code; and

a written diagnosis or reason for this service from the attending

physician.

He's got global dyspraxia, including oral and verbal apraxia.

First, who is the " attending " physician? His pediatrician? His

neurologist? Who is more likely to be more convincing to insurance?

What is a CPT4 procedure code? And which code is most likely to

result in my insurance covering services?

Also, are there any gems I can request they put in their letter? Any

red flag words they need to avoid?

Any other advice?

Thanks!

[Guest guest]

I was approved on a letter deeming medical necessity written by his

nuero-developmental pediatrican. and the code for Apraxia - 784.69

" ALLISON_G "

<allison_g (DOT)

com> To

Sent by:

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et@...

m Subject

[ ] Need help

with insurance letter

12/18/2006 05:45

PM

Please respond to

childrensapraxian

et@...

m

Ok guys and gals, I need your help.

I'm submitting (again) for insurance coverage for speech services.

The last time we submitted, under my old SLP, we were denied because

the problem was deemed developmental, rather than it being from an

illness or trauma (I think they said it needed to be physiological,

or something like that). I just submitted bills from my new SLP and

they've requested the following:

CPT4 procedure code; and

a written diagnosis or reason for this service from the attending

physician.

He's got global dyspraxia, including oral and verbal apraxia.

First, who is the " attending " physician? His pediatrician? His

neurologist? Who is more likely to be more convincing to insurance?

What is a CPT4 procedure code? And which code is most likely to

result in my insurance covering services?

Also, are there any gems I can request they put in their letter? Any

red flag words they need to avoid?

Any other advice?

Thanks!

-----------------------------------------

This transmission may contain information that is privileged,

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use of the information contained herein (including any reliance

thereon) is STRICTLY PROHIBITED. Although this transmission and

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ensure that it is virus free and no responsibility is accepted by

JP Chase & Co., its subsidiaries and affiliates, as

applicable, for any loss or damage arising in any way from its use.

If you received this transmission in error, please immediately

contact the sender and destroy the material in its entirety,

whether in electronic or hard copy format. Thank you.

[Guest guest]

I just looked up the letter and she wrote " this is a letter of medical

necessity for speech therapy to address his neurologically based problem " .

" ALLISON_G "

<allison_g (DOT)

com> To

Sent by:

childrensapraxian cc

et@...

m Subject

[ ] Need help

with insurance letter

12/18/2006 05:45

PM

Please respond to

childrensapraxian

et@...

m

Ok guys and gals, I need your help.

I'm submitting (again) for insurance coverage for speech services.

The last time we submitted, under my old SLP, we were denied because

the problem was deemed developmental, rather than it being from an

illness or trauma (I think they said it needed to be physiological,

or something like that). I just submitted bills from my new SLP and

they've requested the following:

CPT4 procedure code; and

a written diagnosis or reason for this service from the attending

physician.

He's got global dyspraxia, including oral and verbal apraxia.

First, who is the " attending " physician? His pediatrician? His

neurologist? Who is more likely to be more convincing to insurance?

What is a CPT4 procedure code? And which code is most likely to

result in my insurance covering services?

Also, are there any gems I can request they put in their letter? Any

red flag words they need to avoid?

Any other advice?

Thanks!

-----------------------------------------

This transmission may contain information that is privileged,

confidential, legally privileged, and/or exempt from disclosure

under applicable law. If you are not the intended recipient, you

are hereby notified that any disclosure, copying, distribution, or

use of the information contained herein (including any reliance

thereon) is STRICTLY PROHIBITED. Although this transmission and

any attachments are believed to be free of any virus or other

defect that might affect any computer system into which it is

received and opened, it is the responsibility of the recipient to

ensure that it is virus free and no responsibility is accepted by

JP Chase & Co., its subsidiaries and affiliates, as

applicable, for any loss or damage arising in any way from its use.

If you received this transmission in error, please immediately

contact the sender and destroy the material in its entirety,

whether in electronic or hard copy format. Thank you.

[Guest guest]

,

is this MY allison v from GA children's? funny, call me if you find out

anything. I have just written my developmental ped with same question and our

team at children's healthcare is on it to for my daughter. We are also going to

address the issue through our neurologist.

Let's pool our resources. Let me know what you find out and I reciprocate.

Brigett

[Guest guest]

I was approved on a letter deeming medical necessity written by his

nuero-developmental pediatrican. and the code for Apraxia - 784.69

" ALLISON_G "

<allison_g (DOT)

com> To

Sent by:

childrensapraxian cc

et@...

m Subject

[ ] Need help

with insurance letter

12/18/2006 05:45

PM

Please respond to

childrensapraxian

et@...

m

Ok guys and gals, I need your help.

I'm submitting (again) for insurance coverage for speech services.

The last time we submitted, under my old SLP, we were denied because

the problem was deemed developmental, rather than it being from an

illness or trauma (I think they said it needed to be physiological,

or something like that). I just submitted bills from my new SLP and

they've requested the following:

CPT4 procedure code; and

a written diagnosis or reason for this service from the attending

physician.

He's got global dyspraxia, including oral and verbal apraxia.

First, who is the " attending " physician? His pediatrician? His

neurologist? Who is more likely to be more convincing to insurance?

What is a CPT4 procedure code? And which code is most likely to

result in my insurance covering services?

Also, are there any gems I can request they put in their letter? Any

red flag words they need to avoid?

Any other advice?

Thanks!

-----------------------------------------

This transmission may contain information that is privileged,

confidential, legally privileged, and/or exempt from disclosure

under applicable law. If you are not the intended recipient, you

are hereby notified that any disclosure, copying, distribution, or

use of the information contained herein (including any reliance

thereon) is STRICTLY PROHIBITED. Although this transmission and

any attachments are believed to be free of any virus or other

defect that might affect any computer system into which it is

received and opened, it is the responsibility of the recipient to

ensure that it is virus free and no responsibility is accepted by

JP Chase & Co., its subsidiaries and affiliates, as

applicable, for any loss or damage arising in any way from its use.

If you received this transmission in error, please immediately

contact the sender and destroy the material in its entirety,

whether in electronic or hard copy format. Thank you.

[Guest guest]

,

is this MY allison v from GA children's? funny, call me if you find out

anything. I have just written my developmental ped with same question and our

team at children's healthcare is on it to for my daughter. We are also going to

address the issue through our neurologist.

Let's pool our resources. Let me know what you find out and I reciprocate.

Brigett

[Guest guest]

Cpt codes are procedure codes unlike 789.64 which is an ICD

diagnosis code. If your plan says illness or injury then you need

to come up with one. Be creative. What caused the apraxia.

Perhaps hypoxia, an injury. Perhaps some other prenatal insult. An

enviromental insult. My policy expressly excludes apraxia. Find

out what CPT codes are covered and go with those. Any large clinic

can give you codes for each insurer. And remeber all policies read

differently. Medical necessity does not really do the job anymore.

>

> Ok guys and gals, I need your help.

>

> I'm submitting (again) for insurance coverage for speech

services.

> The last time we submitted, under my old SLP, we were denied

because

> the problem was deemed developmental, rather than it being from an

> illness or trauma (I think they said it needed to be

physiological,

> or something like that). I just submitted bills from my new SLP

and

> they've requested the following:

>

> CPT4 procedure code; and

> a written diagnosis or reason for this service from the attending

> physician.

>

> He's got global dyspraxia, including oral and verbal apraxia.

>

> First, who is the " attending " physician? His pediatrician? His

> neurologist? Who is more likely to be more convincing to

insurance?

>

> What is a CPT4 procedure code? And which code is most likely to

> result in my insurance covering services?

>

> Also, are there any gems I can request they put in their letter?

Any

> red flag words they need to avoid?

>

> Any other advice?

>

> Thanks!

>

>

[Guest guest]

Sorry I'm so late in getting back to this -- I've been out of town.

Myra, would you mind emailing me a copy of that letter?

Thanks,

allison

>

>

> I was approved on a letter deeming medical necessity written by his

> nuero-developmental pediatrican. and the code for Apraxia - 784.69

>

>

>

[Guest guest]

Has anyone dealt with Kaiser? Kaiser denied therapy services for my 4 year

daughter Katelyn who is diagnosed with dyspraxia because they don't consider it

medically necessary. I am planning to appeal. They referred me to the school

district for therapy services. My daughter has been receiving services through

the school district since she was three but I feel my insurance should cover

treatment as well. I recently had to request the school district have a fully

trained therapist work with my daughter. There is a shortage of speech

pathologists in my area and an intern (without her CFY) was working with my

daughter. They said she was supervised 25% of the time but in a four month

period the supervising pathologist had only seen my daughter once. (and that was

the week of my IEP review) The district said that an intern is qualified under

" no child left behind. " The Kaiser pathologist felt strongly that an intern did

not have the qualifications to treat a child with

dyspraxia. It took a really bad IEP meeting and talks of an appeal before the

school district said I could take my daughter to the elementary school she will

attend next year for therapy.(that therapist has 14 years of experience and is

prompt trained) I did have to go from 3, 20 min. individual sessions and 1, 20

min. small group session to 3, 30 min. individual sessions. Katelyn actually

gets 10 more minutes of therapy a week but I am worried about losing a day.

Kaiser actually recommend going to 5 therapy sessions a week due to her not

making progress. They can make recommendations and see her every 6 months for

follow up but will not cover treatment. It's so frustrating. I want Kaiser to

cover when she's on vacations so she does not have more than a 2 week break in

treatment. The school district is also talking about getting a communication

devise for my daughter before she starts kindergarten. Does anyone use one? Any

information you can share would be appreciated.

Thanks, Lola

[Guest guest]

I'm not sure which state you are in, but if your income qualifies in

California and you have Healthy Families, you can get Speech & Occupational

Therapy if your child's doctor refers you. (I just found this out yesterday

when I got their new " What is & isn't covered " package.)

I am planning on bringing my daughter's school Speech Therapists' report on

her speech to prove the ST necessary; I know my daughter will not speak to

the doctor and the school ST recommended I get a second opinion on the

diagnosis of Verbal Apraxia.

I know most states have medical insurance for lower income families. Maybe

you can check into that? California has a program through Healthy Families

that you can apply for if your child has a " disability " . This includes the

need for O/S/Physical therapies.

Hope that helps.

Aubrey