Denied, denied, denied

For those of you following our battle with Blue Cross and speech therapy coverage, we have a final answer.

We appealed through the State of NY and they later sent us a letter saying they were sending all of the info to an “impartial” 3rd party in Massuchusetts for review by medical professionals. I really thought this was going to work in our favor and this was all going to end well. I was shocked to receive the final denial from them along with some notes from the three professionals who reviewed the case. I was shocked especially to see the notes from a SLP stating services weren’t necessary. I just was blown away by this, especially when considering his neurological diagnosis and our supporting letters from the neurologist! I am convinced the insurance company must have these “professionals” in their back pocket because there is no good reason for a denial. My neurologist was even very shocked, saying she had never seen anything like this before and that it didn’t make sense.

Blue Cross is SO SO SO lucky that we are fortunate to have a fantastic SLP at school and that they added more sessions to compensate for this denial. Otherwise I would come after them so hard they wouldn’t know what hit them. This is all despite in their letter saying, “this is final, please don’t contact us on this matter again”. We are dealing with so much right now outside of his speech that I had to let this go. Like I said, they were lucky. I can make a huge pain in the butt of myself if the cause is right. But Blue Cross is permanently on my s*%t list.

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6 thoughts on “Denied, denied, denied

  1. I feel this way about Cigna. I’ve heard bcbs is better about covering for apraxia– but maybe not since you got denied. I hate insurance companies! Cigna so far is telling me my daughters therapy is not a covered benefit because its a short term rehab in the same category as chiropractic care. Ugh!

    • Have you appealed with Cigna? I did win my first 2 or 3 appeals and had services for a while at least until he turned 3. If you need help with appeals (like the letter writing and supporting documents) let me know because there is someone I can connect you with that helped me so much. I say fight it! :) Good luck

  2. Linda I would love any help with appeal letters and supporting documents! Cigna has paid for nothing thus far– it’s ridiculous how much they give me the run around! My email address is katepeden@yahoo.com. My daughter has epilepsy and apraxia! Seems common that kids with seizures also have apraxia.

  3. Have you gotten anywhere since this blog post with your insurance company? Our 4.5 year old son was diagnosed with sever apraxia/dyspraxia in November just after his 4th birthday, and we’re currently in the file/denial/appeal/denial cycle with BCBS. Ugh. I sent a bunch of supporting documents and letters, too. Glad I found your blog!

    • hi Lea! Keep trying with BCBS because every state is different. At the time our insurance was out of NYC. But now that we have BCBS out of Mass (My husband changed jobs) he can get some therapy coverage. It’s harder over the age of 3 because they assume they are getting services in school. My recommendation would be to prove he needs more than what he can get in school and the specific therapy he needs for apraxia is not provided at school because they are not trained (in K-SLP or Prompt or whatever). I went through 3 appeals I think. They want you to give up so don’t. Ask for impartial review (where SLPs review the case etc). That’s what ours finally came to, but again, I think it was because it was NY. It’s such a bummer and doesn’t seem fair. I’m sorry you are battling this. If you would like to see copies of my appeal letters I can dig them up for you so you can see how I went about it. Take care

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