Monday, May 24, 2010

new hurdles

I've made peace with our preschool situation. I'm grateful we have what we do, even if it's not everything I'd like. I'm trying so hard to step up and supplement more at home, which is what I BELIEVE in. It's just easier said than done. We're just a couple weeks from the end of the year and then I'm hoping like crazy that I can use the summer to find a good routine for practicing speech, counting and ABC's at home.

Meanwhile, this weekend we got a letter from our insurance company telling us that they denied our request for more therapy visits. Here's how it works - we get 30 visits per calendar year per individual. These visits include speech therapy, occupational therapy, physical therapy, any kind of behavioral therapy, etc... Just 30 a year - not even once a week. We requested more, which is the first step (and hopefully the only one necessary). They said we couldn't have more visits. Now we face an appeals process that could take 6 months if we have to go through all 3 levels. They continue to pay once you start the appeal process but they will ask for the money back if they never approve.

Carver goes to speech 2x/week and we've elected not to do any other therapy for the sake of time, sanity and money. Really, his speech is his most noticeable delay. Besides not being potty trained or knowing how to ride a bike, etc... but those things don't show quite as often. :)

If insurance doesn't cover therapy, we're looking at around $200 a week in therapy costs. Or we could scale back to $85-100/week if we go down to one day. Obviously, this is a significant cost. And a huge dilemma. How can we NOT get the help we need for Carver? But how can we justify so much money out of pocket? Where will it come from? Is it worth draining our savings account for a few years of speech therapy? These are hard questions.

First step - write to the insurance company. They wrote:

"This benefit restriction is not a determination of medical necessity. This denial is for payment purposes only. if you choose to receive the service, you will need to assume the cost."

Does this mean they don't care that therapy is medically necessary? Is that really irrelevant? How can health insurance deny medically necessary treatment? How are we supposed to get the care we need in a medical system built around the concept of insurance if the insurance won't participate? It's incredibly frustrating.

And so I'm incredibly frustrated. Disappointed. Overwhelmed. Discouraged.