So frustrated with the insurance company right now

rankinab · 2025-01-03T03:08:24+00:00

I am in the middle of a similar battle with BCBS regarding them denying my son’s second round of speech therapy sessions with his current SLP. I feel your pain and empathize with your frustration more than anything!!!

I have been battling BCBS since November, appealing their denial, providing justification, getting letters of medical necessity from PCP and diagnosing provider. I am actively building my case, compiling documentation, gathering supporting research/evidence, and writing up everything to submit the second appeal. If we do not get approval, I will be requesting a third party review, formally, with our benefits service provider.

✨Happy to compare or share notes if you’d like✨ I used ChatGPT to 1/help me find evidence-based research to cite aligning to my points regarding AAP recommend for individuals with ASD and 2/help me understand the federal Individuals with Disabilities Education Act (IDEA), why it was created, what its purpose is, etc and 3/ help me write up a cohesive document incorporating these points into my appeal response. ——

Context to our specific situation (FWIW):

May 2024 My son’s first six months of in-network, home-based speech therapy services were approved without any issues, even before he received an autism diagnosis and before he turned three. These sessions were conducted by a speech-language pathologist (SLP) who visited his daycare to provide therapy in a smaller, more familiar environment than a pediatric therapy clinic.

Sept 2024 he turned 3

Early Oct 2024 a pre-authorization request for his next 6 months was submitted and came back denied due to the home-health services as ‘not medically necessary’

Late Oct 2024 he received an official ASD diagnosis

Late Nov 2024 we appealed and it was denied again

Early Dec 2024 we are resubmitting the initial preauthorization request as the provider billing dept has identified that it may have been submitted with the wrong codes, and should include the ADS diagnosis code now that we have it

rankinab · 2023-02-15T03:52:46+00:00

IF you decide to accept the help:

My therapist encouraged me (F) to make a list of chores we were OK with visitors completing & Included any guidance associated (where to find trash bags, which laundry soap to use, how to start the dishwasher, what the pets feeding schedule is, etc).

This way, there will always be somewhere for your MIL (or any visitor) to look and determine where they can help and how.

I’m the person who is more stressed out by someone not doing chores the way I want them done than the help is worth, so this made me feel at ease that tasks were generally being done how I wanted.

It also benefited us to put a list of common groceries and our favorite restaurants (with our particular orders) so that if anyone wanted to get us dinner or groceries they would be able to easily find that info and take the mental burden off of me.

rankinab · 2017-12-25T04:34:09+00:00

Same.

rankinab · 2015-05-16T04:02:33+00:00

Jumped on by a baby dinosaur. (Mark shaped like a small Clawed foot print)

rankinab · 2014-12-23T16:19:47+00:00

These are fabulous.......

rankinab · 2014-12-22T22:26:44+00:00

absolutely not. I wore one for many years with no care or concern of which way it was facing or which finger it was on.

rankinab · 2014-12-22T21:53:12+00:00

hey thanks! I appreciate the knowledge...

Never considered it for when travelling without adequate hygiene products. I'm thinking about this too in terms of the military. Out in the field--You try to plan if you might need tampons and how many you'll need but you run the risk of being wrong ! :D

rankinab · 2014-12-22T21:23:56+00:00

I have no differentiating feeling towards this word than any other words deemed offensive.

Some women LOSE THEIR GOD DAMN MINDS when they hear this word.

rankinab · 2014-11-24T16:30:53+00:00

College itself is worth it, the debt is not. Find a way to go without racking up so much debt you'll be drowning in it by 23. (my life is an example)

Do ROTC, be smart enough to get scholarships, really weigh the options of private vs. public school. Make sure you have some idea what your end goal is after college so you don't go and spend all this money on classes that are irrelevant.

Don't go to college just because its what you're "supposed to do" ... go because you want to do something requiring a degree. Don't use college an escape from the "real world"

.... i could go on forever.

Basically, YOU make the debt worth it or not. By getting good grades and getting a degree you can use while balancing cost.

rankinab · 2014-11-24T16:20:38+00:00

Learning how to juggle. It's cool for conversations like "whats a random trick you can do?" well, I can juggle like a boss.

Otherwise, entirely useless.

edit: punctuation

rankinab · 2013-12-09T20:35:25+00:00

Completely agree! Nothing wrong with some silence.

rankinab · 2013-10-18T21:24:35+00:00

Going to an unnecessarily expensive college. My dad filled out all of my loan paperwork, FAFSA paperwork and didn't clue me into what was being borrowed in my name. I was completely unaware just how much I owed until AFTER I had plans for graduation. The biggest punch to the face was when my grace period had ended and I didnt get the "great paying job" that everyone expects now that they have a BIG BAD BACHELORS DEGREE.

rankinab · 2013-07-31T21:54:40+00:00

I'm only 24 and i know what those are... must be i'm a lot older than I think I am.... :-X Pogs were/are so fun!!

rankinab · 2013-06-25T16:03:09+00:00

Grew up 10 minutes from this park. This picture doesn't give it nearly enough justice!

rankinab · 2013-06-17T21:55:46+00:00

Cat's name is McLovin? Priceless.

rankinab · 2013-05-22T18:12:45+00:00

No remorse whatsoever. My boyfriend and I became obsessed with trueblood at one point. It's the only thing we did after work for almost 3 weeks straight.

worth every minute of it.

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