I just wanted to update this post in the event others are going through the same insurance headaches. The health care advocate rep called me two days ago to let me know that my son's speech therapy WILL be covered. She can't fully explain what happened but it appears the initial claim denial was put through on a different code. Fast forward to now and SO far, all of his sessions have been covered at 90%. She said the code was changed to a medical diagnostic code (Chronic ear infections) I don't fully trust that everything will continue to be covered but for right now, in this moment, I will do a happy dance. Moral of the story: Do NOT take no for an answer!!!!
Need to vent. Early in December, my company's healthcare concierge (middleman/advocate) did some legwork and told met DS' speech therapy evaluation AND services would be covered. They gave me a list of providers. I found a great place from the list. The office manager told me the pre-auth went through and I should be good to go. Fast forward to today and a phone call saying "Sorry but unfortunately Aetna has denied coverage."
I immediately called our advocacy hotline. They are at a loss as well. I haven't gotten a straight answer yet. He saw a different private speech therapist in the fall and both sessions went through Aetna and were fully covered. Who knows, it could be a bad diagnostic code, a simple clerical error but I'm not so sure. I'm now looking at $75 per 30min session 2x a week. That's a big chunk of change each month. I went the private route because EI services are on a sliding scale here in NJ and I would have to pay $101 per session. I will pay whatever I have to pay to help my boy but I am just so frustrated that it costs SO much to get him the help he needs.