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Question about insurance companies and private therapies

surfergirl28surfergirl28 member
in Special Needs

DD just finished up with the Birth to Three program. Even though she will receive OT and PT through the school system now, we have been planning all along on continuing to see her B-3 therapists on a private basis via insurance.

BUT, yesterday when I called to give our insurance information to the clinic, she told me that our insurance considers that clinic and those therapists at out of network. CRAP!

I plan on calling the insurance company to see if maybe they'll let us see those therapists on an "in network" basis or if there's any way around this, but I thought I'd see if anyone here has experience fighting something like this.

Thank you!

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Re: Question about insurance companies and private therapies

  • skittles_123skittles_123 member
    There is a process where you can appeal in most cases by writing a letter. Explain to them why these particular therapists are the best fit for your child and also mention that they are most familiar with her case, as they have worked with her since she was born.
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  • surfergirl28surfergirl28 member
    So do I need to contact the insurance company first, and then let them know I'll be submitting a letter? Or just submit the letter? If I contact the insurance company, should I ask to speak to someone in a specific department?
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  • cranberry27cranberry27
    Talk to the clinic too.  They have a lot of experience with insurance, and it might be easier for them to get multiple therapists coordinated with an appeal.  The therapists might be able to write something as well.  Get together and your chances are better!
    Lilypie First Birthday tickers Lilypie Second Birthday tickers imageimage
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  • minnasmommyminnasmommy member

    hi there.

    do you have out-of-network benefits? ?I agree--if at all possible she should continue with the therapists she's had for her whole life...it would be awful if they don't let you!

    Hope everything is good with you girls! :)?

    Sisterly love--Sophia (1/14/07) and Baby Margaux (7/13/10) image Doctor in training! :)image
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