Need advice on dealing with an insurance issue

ash2

I'm so furious right now! Before my son started his speech program at KKI back in November, their benefits coordinator contacted our insurance company to verify benefits. She was told exactly what I had been told, that we were covered at 100% with unlimited visits and no exclusions. Today I received three EOBs in the mail for his first visits in the mail and discovered that they are billing it as out of network. I called them and they said that while Kennedy Krieger is in network, the speech part of it is not. Of course we are fighting this because we have proof of them telling us otherwise. They even have the notes in their system where our benefits were verified on Nov. 5th and Jan. 5th by someone at Kennedy Krieger. My husband is talking with his Benefits manager right now and the Benefits coordinator at Kennedy Krieger will be calling them as well and will appeal it if need be. Is there anything else I should be doing? So far with just the claims they have filed, it states our portion of what we owe is over 10k. We certainly don't have the money to spend 10k on therapy every 2 months.

Justinlove

Do you have it in writing that speech, from XX therapist, is covered under your plan or are you just relying on phone conversations?  Hopefully you have it in writing as it will make is much easier to fight. 

Also, in your plan, you should have a complete list of in-network providers for therapy.  Find where it lists the specific speech therapist (or thearpy group) that your child is attending. 

Going forward, it is best to always get coverage verifications--it can save you a lot of headache.

MirandaHobbes

I've dealt with this once before- I always email my questions about coverage to our insurance provider. They are forced to reply with a name and I keep all of them. Unfortunately for me, I still didn't win the issue because I hadn't worded the question exactly right (I was asking about what the total cost of birth was going to be, with deductibles, copays, etc. I neglected to ask about the cost of my yet-to-be born son, who unbeknownst to me had a deductible of his own!). Insurance is tough, I find that I'm always asking the wrong question. Like when I asked if they covered "autism treatment" and they said no- it took me a good 6 months to figure out what I needed to ask was whether they cover ST, OT, etc (which they do). Hopefully you'll find some resolution to your issue.

[Deleted User]

Is your insurance provided by your employer?  If it is, you can ask your director of HR to call his/her insurance account rep on your behalf.  It is in the insurance's best interest to please the HR director.

I had this happen with my son's medflight.  The hospital and I called on multiple occasions to make sure that his medflight was covered. Each time, they answered, "Yes it's covered 100%."  What they really meant was that it was covered 100%, up to the benefit limit of my plan...which was only $1,000.  So I received a surprise bill for $12,000!  But my HR director called the insurance company and asked them to pay AND THEY DID.

Good luck!