Getting insurance companies to pay for children's therapies: 9 hacks

I've previously covered ways to get the insurance company to pay for your child's therapies, including these tips and the time I was just joking about cc-ing God. (Not to mention my fed-up-with-insurance-companies posts, like this.) I've got new hacks, inspired by some recent success with my insurance company, tips from Facebook readers and one seemingly genius hack shared by reader/parent Dale McCarthy (who just started Respect for All Abilities, which offers customized school disability awareness programs). Here's how to get reimbursed for a child's speech therapy, occupational therapy, physical therapy, ABA therapy and more. 

Find a point person
At our current insurance company, there are no case managers you can be assigned to. But I did find one truly competent and nice supervisor who I could reach out to for help with claims that weren't paid. The next time you're fighting a claim, ask for a supervisor; if he or she knows what they are talking about (not always the case), either get their phone number or ask if you can request them. And then, going forward, either call them when you have a claims issue or get a message to them to call you so you don't waste your time with clueless representatives. As reader Teresa Brown says, "Often the people who answer the phone are the least experienced and knowledgeable, or their authority is limited."

Do it their way
It's simple but something that's easy to forget amid the bazillion other things you have on your plate: Submit claims exactly the way the insurance company wants you to. "Follow the (exquisitely detailed) instructors to the letter—they're often in your statement of benefits or the insurance company's website," notes reader Amber Kay. "Physicians' authorizations must be signed in BLUE ink. Use paper clips NOT staples. Whatever."

Use a different code
The CPT (Current Procedural Terminology) code are the numbers speech, occupational and physical therapists (among others) put on bills for treatments done during a session. If you're getting denied for one code, talk with the therapist about trying a different one on subsequent bills. If that therapist doesn't know, see if she can ask colleagues. Recently, I asked therapists to change the ICD (International Classification of Diseases) code—aka diagnosis code—on our bills. They'd been using "stroke." When we changed it to "cerebral palsy, unspecified" the speech bills previously denied were put through.

Emphasize medical necessity
When speech sessions have been denied, I've had Max's neurologist and pediatrician write letters of medical necessity explaining that oral-motor therapy (part of speech sessions) are a medical necessity to help prevent choking. "For speech, we often use the idea that the child can't communicate hurt or illness as a medical necessity, especially if they have medical diagnoses that are relevant," says Evana Sandusky, a pediatric speech language pathologist and mom of a child with Down syndrome. "I have also used medical necessity if the child can't give basic info like name, age or parents name in case they get separated or lost."

Know your rights
The majority of states now have insurance mandates for autism, meaning they require certain insurers to provide coverage for autism spectrum disorder. Specifics vary between states. See the list of states here and what their plans entail.

Try, try again
If your child was denied a therapy session for lack of medical necessity, ask your child's therapist and doctors to write letters of medical necessity. Include notes from sessions as well. If your child gets therapies at a hospital, see if there is a social worker who works with patients on healthcare insurance and if so, get her to guide you. You can also reach out to the Patient Advocate Foundation, a nonprofit that handles health insurance appeals for free; reach them at 800-532-5274.

And then there's this
While I can't vouch for this strategy as I haven't tried it, it seems worth a shot if you have gotten nowhere.

Keep track
"Keep good notes: date and time of call, name of person, title/dept. and what you were told," says Teresa. "The devil really is in the details."

Doctor doesn't even accept insurance?
"Ask if the office if they are associated with a clinic or office that does accept insurance," recommends reader Shannon Luhrs. "That way, you can see the people you want to see and bill through the associated office."

"Wine. Maybe vodka."
That's the winning tactic reader Marla Huseman Grace recommends for dealing with insurance companies. Cheers!

My left knee is about to get very buff

So, it's official: The doctor called tonight to say I have a torn ACL (anterior cruciate ligament), one of the four major ligaments of the knee. This means I will probably never be a professional athlete, which is fine, since now I can focus on my dream of becoming a rock star and/or President of the United States and/or fudge taste tester.

My knee doesn't hurt much unless I move it the wrong way or Sabrina jumps on it. I'm supposed to go to physical therapy which is fine, too, because I am going to have the most buff, in-shape left knee of anyone. And you thought it looked so svelte in the x-ray—just you wait and see how sexy my knee is going to be!

Perhaps you have guessed that I am not really fazed by this whole knee thing. Maybe it's because after those two weeks of NICU hell when Max was born, any health glitch (especially my own) seems like a mere nuisance. Maybe this is just typical of most moms—I don't have time to throw my knee a pity party. Honestly, my only real concern is carrying Max down (and sometimes up) the staircase in our home; I need two steady knees for that. So far, so good.

My friend Hedy says having a torn ACL is a badge of honor, because it's a common sports injury. I just Googled it, and apparently, I am in excellent company as World Wrestling Entertainment diva Melina suffered the same exact injury the other week, a woman described as being "just as dangerous as she is beautiful," which is what people say about me all the time. Another coincidence: Her "signature ring entrance" is a "sexy split." Which is so funny, because that is exactly what I do whenever I take the kids to their friends' birthday parties.


And we look alike, too!

Anyhoo, if you know someone who is not Melina who has survived an ACL tear (and, bonus, has gone on to be a rock star, POTUS or fudge taste tester), let me know.

Oh, and belated thanks to Lynn from the very entertaining blog Midday Escapades for the nice words about this blog, and to all of you who have been e-mailing me. Me and my left knee much appreciate it.