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.