Thursday, December 4, 2008

They better hope it's a mistake or some misunderstanding...

Our mailman is a slacker. He looks like he's 16 and a total smoker. We're lucky if he arrives by 5 p.m. - often times, like today, he delivers our mail after dark. This can cause problems like it has this evening. You see, in today's mail was an explanation of benefits (EOB) from our insurance company DENYING coverage for Will's speech and occupational therapy he's been receiving since June. According to the EOB, these services aren't "medically necessary" and since our insurance only covers things that are "medically necessary," they won't cover the services.

This is interesting. Back in June, I called our insurance company to see if things like speech and occupational therapy are covered under our policy. I was informed that they are as long as we have a doctor's referral. Well, we have one of those, so I'm not sure what the problem is. Even more interesting is the fact that they had previously approved coverage according to early EOBs, so why now are they denying coverage? I'm guessing it's because some pencil-pusher that the insurance company pays six figures to annual to review files and deny coverage finally came upon ours and decided that Will doesn't medically need speech and occupational therapy. Of course, this is just a guess because I can't actually find out what's going on because our mail was delivered so late and it's too late to call! Actually, it's probably a good thing because I'm emotional, and emotions and insurance companies don't mix. I'm going to have to put on my mommy/lawyer hat tomorrow morning when I make the call.

Let Cigna deny coverage for these services. I will write to every news outlet I can think of to tell our story. I think it's a captivating one - NFL player's 4-year-old son denied treatment. Hm. I bet I can find some interested parties in this story.

On a good note, I have some Will-isms for the day. Will was looking at a book this morning and grabbed Ryan's finger and pointed at an exclamation point and asked what it was. He literally said, "What is this?" He asked the same question about a question mark. I guess he recognized all the letters on the page but not the punctuation.

Even cooler - Will and I were playing this afternoon. I put my hand on my hips because I was tired of chasing him around. He put his hands on his hips. I put my arms down at my side - so did he. He was actually copying my movements. I was able to get him to do it again this evening - he even copied when I did spirit fingers! Ryan wasn't too happy about that and I promised I wouldn't make Will do that again! :)

It would just be devastating if we had to stop his services because our insurance company won't cover them. We aren't rich - nowhere close. We would not be able to afford to continue Will's services. So please send us some good vibes - I'm gearing up for a fight!

5 comments:

amy (metz) walker said...

wow, sorry to hear they denied it, but I'm going to assume its just some mistake. That's so incredible that you are seeing progress...and the spirit fingers story made me laugh!

Get 'em!

Barbara said...

I have communtiy blue, and i received a bunch of denials before for mikey's services. I called and they said we were over our limit - WTH?? BUT, we were still covered for services because of his EIP thru the school system (summit) and our school district (cheek/sloan). Check that angel and see how it works for you - i know how you feel, cuz i flipped out crying when i thought we had to stop when we were making strides! Hang in there!

Kembree said...

I'm sending you positive energy..but couldnt help but laughing about your mailman and the spirit fingers, our mailperson is on some weird schedule, we NEVER know when she will come, but more of the Grandma type..

Sarah Sape said...

That's Cigna for ya! Whatever is necessary (i.e.: womens yearly, remember that)they'll won't pay. Just think of all the infertility things they won't pay for either. This future kid is costing us over $10,000! Anyhow, got get em Dawn! Be sure to write the reps name as Cigna screws up often. Youre a lawyer, get everything in writing.

Anonymous said...

Good luck fighting the insurance company. I will be keeping you and your family in my thoughts.

-An avid reader