WTF is the purpose of insurance if no one is in ne

[Deleted]

network.

DS2 was referred for OT.

I check my insurance site. The closest covered OT is in fucking Alabama.

Private pay is $500 for the first appt and then generally 2 appts a week at $100/appt.

[ringstrue]

idk I'm freaking out about this with my new, possibly crappier ins.

[copzgirl1171]

If there is none local sometimes calling your insurance helps because they may be able to recommend someone or at the worst they may have you make the appt and submit the bills to be reimbursed.

Do you have a childrens hospital in network?

[ecupirate04]

Even with where you are located? That is really surprising.

[Deleted]

Jun 19, 2012 12:50:42 GMT -5 @copzgirl1171 said:

If there is none local sometimes calling your insurance helps because they may be able to recommend someone or at the worst they may have you make the appt and submit the bills to be reimbursed.

Do you have a childrens hospital in network?

I've been sitting on hold with ins co for 15 minutes waiting to ask them.

There is a children's hospital in network but we are a 40 minute drive from it.

[copzgirl1171]

You could get your OT of choice to apply to your insurance company if they are agreeable, but that will set you back months in therapy waiting.

This sucks, I am so sorry

[marissa]

We have appealed before and had them pay for specialist as if they were in network.

[Deleted]

The cigna rep says they have one in network but google says he's an MD not OT and he's speciality is Emergency Medicine.

I'm on hold again but I'm going to have to figure out how get them to cover someone locally and get someone to agree to bill cigna.

[4speedy]

If you don't mind me asking, why does your child need OT? I have been dealing with insurance and OT for close to a year for treatment of my son's sensory processing disorder. I've recently had success appeailing a denial. I would be happy to share my experience, if it pertains to your situation. If the OT is for some other medical need, I would suggest going to an OT that is employed through a hospital that takes your insurance rather than a private practice OT. You would generally have more luck.

ETA: we're heading out to the beach so I won't be able to reply until tonight.

[Deleted]

Jun 19, 2012 13:36:06 GMT -5 4speedy said:

If you don't mind me asking, why does your child need OT? I have been dealing with insurance and OT for close to a year for treatment of my son's sensory processing disorder. I've recently had success appeailing a denial. I would be happy to share my experience, if it pertains to your situation. If the OT is for some other medical need, I would suggest going to an OT that is employed through a hospital that takes your insurance rather than a private practice OT. You would generally have more luck.

ETA: we're heading out to the beach so I won't be able to reply until tonight.

Sensory Processind Disorder and ASD.

I would suck it up and pay out of pocket but we are already paying out of pocket for SD's therapy and we have met the out of pocket limit for in network already for the year.

I have a call into the SpEd coordinator at school to see about revising his IEP.

[marissa]

Jun 19, 2012 14:08:52 GMT -5 @septimus said:

Jun 19, 2012 13:36:06 GMT -5 4speedy said:

If you don't mind me asking, why does your child need OT? I have been dealing with insurance and OT for close to a year for treatment of my son's sensory processing disorder. I've recently had success appeailing a denial. I would be happy to share my experience, if it pertains to your situation. If the OT is for some other medical need, I would suggest going to an OT that is employed through a hospital that takes your insurance rather than a private practice OT. You would generally have more luck.

ETA: we're heading out to the beach so I won't be able to reply until tonight.

Sensory Processind Disorder and ASD.

I would suck it up and pay out of pocket but we are already paying out of pocket for SD's therapy and we have met the out of pocket limit for in network already for the year.

I have a call into the SpEd coordinator at school to see about revising his IEP.

Have you thought about supplemental insurance, i.e. a medical card? Not every state has the same requirements. I know where we are is difficult to get more help but my uncle has a medical card to help with my cousin who has an issue with UV light.

[lilibet]

I'm sure you're done with this by now but I just wanted to throw out that the company I work for does waivers basically where if there isn't an in-network provider of the type of provider that you need within so many miles of you (I think it is 50) you can fill out a form and they will allow that provider's claims to be processed as in-network. They are usually done for x number of visits or x number of months but you then just have to send in a new form. I don't know if that would be an option for you guys. It does totally suck, sorry you are having to deal with this.

[2vermont]

Jun 19, 2012 20:01:48 GMT -5 lilibet said:

I'm sure you're done with this by now but I just wanted to throw out that the company I work for does waivers basically where if there isn't an in-network provider of the type of provider that you need within so many miles of you (I think it is 50) you can fill out a form and they will allow that provider's claims to be processed as in-network. They are usually done for x number of visits or x number of months but you then just have to send in a new form. I don't know if that would be an option for you guys. It does totally suck, sorry you are having to deal with this.

I was going to suggest something along these lines.

[pugz]

the fact that you have Cigna answers the question, they are assholios in the insurance world. Not as bad as United Healthcare, but pretty darn close. Humana is also on my current shit list...

[2vermont]

Funny you guys are saying this about Cigna. In my last job where I would have to contact insurance companies regarding payment denials, etc, they were the worst to deal with as a provider as well.

[Deleted]

We are getting a new insurance company in January but that doesn't hellp me now :-(.