Re: Insurance frustrations

[Guest guest]

,

Find a children's hospital near you that accepts your insurance, they most

likely have a developmental pediatrician on staff.

-BJ in polis, MD

[Guest guest]

Recently I called my insurance to see if they had any developmental

pediatricians in network. The insurance rep was confused. After some back

and forth, the rep I talked to tried to convince me that dev peds *did not

exist* because he had never heard of one. Who knew that dev peds were a

figment of my imagination? So I pressed further:

me: you do cover the cost of diagnosis, right?

Them: we cover the costs of ruling out autism

me: huh?

Them: we only cover testing for medical conditions to rule out autism, say

like Fragile X and metabolic disorders

me: this is what your website says about diagnosis autism: " The following

services may be included in the assessment and treatment of the patient's

condition: A. Parent and/or child interview (including siblings of children

with autism) B.Medical evaluation (complete medical history and physical

examination)

me: wouldn't that include being seen by a dev ped

Them: again, I don't know that there are peds who specialize in

developmental delays, but we only cover clinical issues arising from autism

me:

In case you were wondering, according to them there are no therapies to

treat autism that have stood up to peer review: " Aetna does not cover

intensive intervention programs such as Lovaas Therapy (also known as

applied behavior analysis, or discrete trial training), the Rutgers Program,

the LEAP Program, and the Denver Program, the Autism Pre-school Program, and

the TEACCH Program for the management of children with autism. The

effectiveness of these programs has not been established in the peer

reviewed medical literature. "

ditto on ST and OT. Doesn't it just make you sick?

(SAHM in GA)

MSN elizabethloht@...

n 33, mo, no formal dx

Phoebe, 10 wks

[Guest guest]

Recently I called my insurance to see if they had any developmental

pediatricians in network. The insurance rep was confused. After some back

and forth, the rep I talked to tried to convince me that dev peds *did not

exist* because he had never heard of one. Who knew that dev peds were a

figment of my imagination? So I pressed further:

me: you do cover the cost of diagnosis, right?

Them: we cover the costs of ruling out autism

me: huh?

Them: we only cover testing for medical conditions to rule out autism, say

like Fragile X and metabolic disorders

me: this is what your website says about diagnosis autism: " The following

services may be included in the assessment and treatment of the patient's

condition: A. Parent and/or child interview (including siblings of children

with autism) B.Medical evaluation (complete medical history and physical

examination)

me: wouldn't that include being seen by a dev ped

Them: again, I don't know that there are peds who specialize in

developmental delays, but we only cover clinical issues arising from autism

me:

In case you were wondering, according to them there are no therapies to

treat autism that have stood up to peer review: " Aetna does not cover

intensive intervention programs such as Lovaas Therapy (also known as

applied behavior analysis, or discrete trial training), the Rutgers Program,

the LEAP Program, and the Denver Program, the Autism Pre-school Program, and

the TEACCH Program for the management of children with autism. The

effectiveness of these programs has not been established in the peer

reviewed medical literature. "

ditto on ST and OT. Doesn't it just make you sick?

(SAHM in GA)

MSN elizabethloht@...

n 33, mo, no formal dx

Phoebe, 10 wks

[Guest guest]

Yes, it does make me sick. Arrgh.

Maggie

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[Guest guest]

I feel your pain.

I had a very similar conversation with our insurance company not to long

ago.

I want to smack all these people.

Georga

Re: Insurance frustrations

>

> Recently I called my insurance to see if they had any developmental

> pediatricians in network. The insurance rep was confused. After some

back

> and forth, the rep I talked to tried to convince me that dev peds *did not

> exist* because he had never heard of one. Who knew that dev peds were a

> figment of my imagination? So I pressed further:

>

> me: you do cover the cost of diagnosis, right?

>

> Them: we cover the costs of ruling out autism

>

> me: huh?

>

> Them: we only cover testing for medical conditions to rule out autism,

say

> like Fragile X and metabolic disorders

>

> me: this is what your website says about diagnosis autism: " The

following

> services may be included in the assessment and treatment of the patient's

> condition: A. Parent and/or child interview (including siblings of

children

> with autism) B.Medical evaluation (complete medical history and physical

> examination)

>

> me: wouldn't that include being seen by a dev ped

>

> Them: again, I don't know that there are peds who specialize in

> developmental delays, but we only cover clinical issues arising from

autism

>

> me:

>

> In case you were wondering, according to them there are no therapies to

> treat autism that have stood up to peer review: " Aetna does not cover

> intensive intervention programs such as Lovaas Therapy (also known as

> applied behavior analysis, or discrete trial training), the Rutgers

Program,

> the LEAP Program, and the Denver Program, the Autism Pre-school Program,

and

> the TEACCH Program for the management of children with autism. The

> effectiveness of these programs has not been established in the peer

> reviewed medical literature. "

>

> ditto on ST and OT. Doesn't it just make you sick?

> (SAHM in GA)

> MSN elizabethloht@...

> n 33, mo, no formal dx

> Phoebe, 10 wks

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Same thing here. I don't think I have had an insurance that has paid for any

therapy. ugh. I get told " It isn't a physical handicap and it isnt a mental

illness. " ugh. I guess that means it isnt worth treating. Bleech!

Jacquie H

Re: Insurance frustrations

Recently I called my insurance to see if they had any developmental

pediatricians in network. The insurance rep was confused. After some back

and forth, the rep I talked to tried to convince me that dev peds *did not

exist* because he had never heard of one. Who knew that dev peds were a

figment of my imagination? So I pressed further:

me: you do cover the cost of diagnosis, right?

Them: we cover the costs of ruling out autism

me: huh?

Them: we only cover testing for medical conditions to rule out autism, say

like Fragile X and metabolic disorders

me: this is what your website says about diagnosis autism: " The following

services may be included in the assessment and treatment of the patient's

condition: A. Parent and/or child interview (including siblings of children

with autism) B.Medical evaluation (complete medical history and physical

examination)

me: wouldn't that include being seen by a dev ped

Them: again, I don't know that there are peds who specialize in

developmental delays, but we only cover clinical issues arising from autism

me:

In case you were wondering, according to them there are no therapies to

treat autism that have stood up to peer review: " Aetna does not cover

intensive intervention programs such as Lovaas Therapy (also known as

applied behavior analysis, or discrete trial training), the Rutgers Program,

the LEAP Program, and the Denver Program, the Autism Pre-school Program, and

the TEACCH Program for the management of children with autism. The

effectiveness of these programs has not been established in the peer

reviewed medical literature. "

ditto on ST and OT. Doesn't it just make you sick?

(SAHM in GA)

MSN elizabethloht@...

n 33, mo, no formal dx

Phoebe, 10 wks

[Guest guest]

Did you try appealing the decision with your insurance?

[Guest guest]

Well, if they really want to pay more for it let them.

Idiots.

Georga

Re: Insurance frustrations

> Yep, insurance coverage for treatment of our kids sucks! I was told that

> speech therapy is covered by our BC/BS, but then found out later that it

has

> to be done in a hospital, not a clinic! Jerks! Don't they know how much

> more that would cost them???

> Sue> >

[Guest guest]

Just put it on your taxes as medical expences. That is the best that I can

offer there.

Georga

Re: Insurance frustrations

>

>

> > See. It all worked out.

> > Georga

>

>

> Yeah, but I'm still paying $200 a month out of pocket for it with no

> reimbursement. And of course we didn't get reimbursed for any of it last

> year when it should have bee $400 a month. These people are so great and

> knew needed the services that the school wouldn't provide that the

> owner cut the hourly fee in 1/2 so I could afford to take him! How cool

is

> that?! He's been going for almost 2 years now.

> Sue

>

>

>

>

>

>

>

>

[Guest guest]

>>>>>>>>

In case you were wondering, according to them there are no therapies to

treat autism that have stood up to peer review: " Aetna does not cover

intensive intervention programs such as Lovaas Therapy (also known as

applied behavior analysis, or discrete trial training), the Rutgers Program,

the LEAP Program, and the Denver Program, the Autism Pre-school Program, and

the TEACCH Program for the management of children with autism. The

effectiveness of these programs has not been established in the peer

reviewed medical literature. "

ditto on ST and OT. Doesn't it just make you sick?

<<<<<<<<

Sure does...

They pretty much covered everything, didn't they.

I remember trying to get my insurance company to cover speech therapy. They

wouldn't. They only cover ST if the loss of speech is a result of accident

or injury. huh. Guess kids like ours just can get by without speaking.

They did however cover OT, which was in THE SAME OFFICE.

It's nuts.

[Guest guest]

>>>>>>>>

In case you were wondering, according to them there are no therapies to

treat autism that have stood up to peer review: " Aetna does not cover

intensive intervention programs such as Lovaas Therapy (also known as

applied behavior analysis, or discrete trial training), the Rutgers Program,

the LEAP Program, and the Denver Program, the Autism Pre-school Program, and

the TEACCH Program for the management of children with autism. The

effectiveness of these programs has not been established in the peer

reviewed medical literature. "

ditto on ST and OT. Doesn't it just make you sick?

<<<<<<<<

Sure does...

They pretty much covered everything, didn't they.

I remember trying to get my insurance company to cover speech therapy. They

wouldn't. They only cover ST if the loss of speech is a result of accident

or injury. huh. Guess kids like ours just can get by without speaking.

They did however cover OT, which was in THE SAME OFFICE.

It's nuts.

[Guest guest]

They said I could get my ped to fill out a " non participating referal form "

stating clinical reasons why n needs to see a dev ped. I can then get

approval to go to one. See but I am on to them now. I am guess by

" clinical " they are excluding developmental issues like autism (according to

them). Grrr.

(SAHM in GA)

MSN elizabethloht@...

n 33, mo, no formal dx

Phoebe, 10 wks

Re: Insurance frustrations

> Did you try appealing the decision with your insurance?

>

>

>

>

>