Friday, March 12, 2010
More Aetna Antics
Well, I haven't posted about Aetna in a long time, but they are still up to their old tricks. Since we showed them that they have to cover Daniel's therapy by law, virtually every claim for me that is not for a doctor visit has either been pended or denied. Interesting. Apparently, filing a complaint with the Illinois Department of Insurance wasn't enough to keep them in check. Their latest thing is a denial of my ER visit on Labor Day weekend for a throat infection. Apparently, I wasn't sick enough need medical attention. Before I went to the ER, I searched their website for the nearest urgent care facility, and I found one located right here in Hammond. The problem - I was sick on a Saturday morning, and the urgent care facility is only open Monday through Friday. My doctor does not have Saturday office hours, and he was not available by telephone. I had big white spots in my throat and a fever of 101.7. Apparently, I was supposed to just stay at home and get sicker. The antibiotics that cleared up the infection were a covered expense, but seeing a doctor to get a prescription for them was not. Yet, I never would have gotten a prescription for antibiotics without first seeing a doctor. Way to go, Aetna!
Saturday, January 23, 2010
It's That Time of Year Again
Well, tax season is here, and I will be going back to work for a few months very soon. While I'm not looking forward to working 8 hours every Saturday, I am looking forward to getting a paycheck. I can't believe it's my 5th tax season!
Each year, I usually treat myself to something fun with some of the money I earn. I can't decide what that will be this year. Hmmm...there are soooo many things to choose from!
Each year, I usually treat myself to something fun with some of the money I earn. I can't decide what that will be this year. Hmmm...there are soooo many things to choose from!
Monday, September 21, 2009
God is Faithful!
I got a letter from Aetna this morning, indicating that they were reversing their decision not to cover Daniel's therapy - but only for the month of July! Our initial letter of appeal requested that they reverse their decision not to cover therapy at all for all claims going forward. They must think we're not serious about making sure they follow Illinois law in providing coverage for his therapy.
As I sit here on hold, waiting for their senior representative to see if she can get a definitive answer about coverage for claims going forward from July on, I am planning to forward more information to the Illinois Insurance Commission. In our conference call with Aetna's representatives, we were told that their medical directors were board-certified family physicians. My letter says that a "medical director, board certified in Obstetrics and Gynecology," was involved in the review of our appeal. I find that quite interesting. When did an OB/GYN become a FAMILY doctor?!?!? What are their credentials in PEDIATRIC medicine? I'm sure that Daniel's doctors would be interested to know this. This is why I never believe anything anyone at Aetna tells me, and it is why I take very detailed notes every time I call them.
The findings of this, my latest call - therapy will be covered without limits under the directives of the Illinois Autism Mandate. I have documented the name of the person with whom I spoke, as well as everything she told me regarding how our claims will be handled. We'll see where we go from here. Hopefully, this is the end of the battle. Aetna stole an entire summer away from me and my children, and I will not allow them to steal any more of our precious time. If they do not cover therapy in accordance with the IL Autism mandate, I will seek legal counsel. Enough is enough. This never should have gotten so out of hand in the first place. This law was signed in November 2008, and it was effective for us when our policy renewed on July 1, 2009.
I find it interesting that, when I spoke to Aetna's representatives in June and told them he has an autism spectrum disorder, they told me they do not cover treatment for autism spectrum disorders. Yet, I'm sure they knew about the new law, and they were trying their best to get out of providing coverage, thinking we'd never find out about it. It was signed in November 2008, and it was effective December 18, 2008.
God holds Daniel's life in his hands, and He's not about to let an insurance company get away with such unethical practices. He has a purpose and a plan for Daniel's life, and He will make sure that no one, not even an insurance company, gets in His way.
"And we know that in all things God works for the good of those who love him, who have been called according to His purpose." Romans 8:28
As I sit here on hold, waiting for their senior representative to see if she can get a definitive answer about coverage for claims going forward from July on, I am planning to forward more information to the Illinois Insurance Commission. In our conference call with Aetna's representatives, we were told that their medical directors were board-certified family physicians. My letter says that a "medical director, board certified in Obstetrics and Gynecology," was involved in the review of our appeal. I find that quite interesting. When did an OB/GYN become a FAMILY doctor?!?!? What are their credentials in PEDIATRIC medicine? I'm sure that Daniel's doctors would be interested to know this. This is why I never believe anything anyone at Aetna tells me, and it is why I take very detailed notes every time I call them.
The findings of this, my latest call - therapy will be covered without limits under the directives of the Illinois Autism Mandate. I have documented the name of the person with whom I spoke, as well as everything she told me regarding how our claims will be handled. We'll see where we go from here. Hopefully, this is the end of the battle. Aetna stole an entire summer away from me and my children, and I will not allow them to steal any more of our precious time. If they do not cover therapy in accordance with the IL Autism mandate, I will seek legal counsel. Enough is enough. This never should have gotten so out of hand in the first place. This law was signed in November 2008, and it was effective for us when our policy renewed on July 1, 2009.
I find it interesting that, when I spoke to Aetna's representatives in June and told them he has an autism spectrum disorder, they told me they do not cover treatment for autism spectrum disorders. Yet, I'm sure they knew about the new law, and they were trying their best to get out of providing coverage, thinking we'd never find out about it. It was signed in November 2008, and it was effective December 18, 2008.
God holds Daniel's life in his hands, and He's not about to let an insurance company get away with such unethical practices. He has a purpose and a plan for Daniel's life, and He will make sure that no one, not even an insurance company, gets in His way.
"And we know that in all things God works for the good of those who love him, who have been called according to His purpose." Romans 8:28
Monday, September 7, 2009
My Little Angel Sent From Heaven Above
For the past couple of weeks, Annie's been calling me her angel sent from heaven above, mainly due to the fact that I killed huge centipede in the boys' room, and she's terrified of bugs. Tonight, as I was tucking Josh back in bed after he got up, I told him he was my angel sent from heaven above, and I was struck by the truth in those words. He was our surprise baby, born just 3 1/2 months before my mom died, and I have no idea how I would have gotten through the months following her death if I wouldn't have had a small baby to care for.
Annie was in preschool 3 afternoons a week, and Daniel was in preschool 4 mornings a week. While I had one older child home at all times, Daniel still took naps in the afternoon. Having Josh to take care of was such a blessing! I can remember so many times when I would think of my mom and look at Josh and see nothing but hope in his little life.
I still am filled with hope when I think about Josh. Having a child with sensory processing disorder can be very difficult and discouraging. Watching Daniel struggle through much of his life has been hard, to say the least. Watching Josh outdo himself over and over again is very encouraging, on the other hand. While I have to keep on my toes to stay one step ahead of him, it is absolutely amazing to watch how he interacts with people, and it is wonderful to see him grow and mature. He truly is my little angel sent from heaven above!
Annie was in preschool 3 afternoons a week, and Daniel was in preschool 4 mornings a week. While I had one older child home at all times, Daniel still took naps in the afternoon. Having Josh to take care of was such a blessing! I can remember so many times when I would think of my mom and look at Josh and see nothing but hope in his little life.
I still am filled with hope when I think about Josh. Having a child with sensory processing disorder can be very difficult and discouraging. Watching Daniel struggle through much of his life has been hard, to say the least. Watching Josh outdo himself over and over again is very encouraging, on the other hand. While I have to keep on my toes to stay one step ahead of him, it is absolutely amazing to watch how he interacts with people, and it is wonderful to see him grow and mature. He truly is my little angel sent from heaven above!
Thursday, September 3, 2009
Unbelievable!
Well, Aetna is up to their usual tricks again. What else is new?!?!? This time, it's absolutely ridiculous. We filed our appeal on August 17th and faxed additional info on August 27th. We faxed and overnighted all of these documents when we requested our predetermination for coverage back in July. All of a sudden, the paperwork we sent them on August 27th is "new" information. Interesting, to say the least.
They told us that once a formal appeal was opened, they would allow Daniel's doctors and therapists to do peer to peer reviews. Wrong-o!!! So far, Daniel's doctors and therapists have called for peer to peer reviews, and they have been rejected. His therapists tried calling the same week we filed the appeal, and they were told one hadn't been filed. The flaw in that is that Frank FAXED everything for the appeal, and they most certainly did have one opened on August 17th. Yesterday, they refused to let our pediatrician do one, and they even hung up on her. Nice! I confirmed with our neurologist's nurse that he tried to call late last week, and he was turned away - for a 2nd time!
Apparently, they don't get it. I will not be bullied, and I will not give up on making sure Daniel's therapy is covered as mandated by Illinois law. This is getting rather old.
They did talk to Daniel's developmental pediatrician, but it was only AFTER we faxed them a second copy of documentation stating he meets the criteria for autism spectrum disorder. They never intended on speaking to any of Daniel's doctors about his healthcare needs. Now, they're suddenly interested because they are bound to cover therapy by law. I'm sooooo tired of all these antics.
They told us that once a formal appeal was opened, they would allow Daniel's doctors and therapists to do peer to peer reviews. Wrong-o!!! So far, Daniel's doctors and therapists have called for peer to peer reviews, and they have been rejected. His therapists tried calling the same week we filed the appeal, and they were told one hadn't been filed. The flaw in that is that Frank FAXED everything for the appeal, and they most certainly did have one opened on August 17th. Yesterday, they refused to let our pediatrician do one, and they even hung up on her. Nice! I confirmed with our neurologist's nurse that he tried to call late last week, and he was turned away - for a 2nd time!
Apparently, they don't get it. I will not be bullied, and I will not give up on making sure Daniel's therapy is covered as mandated by Illinois law. This is getting rather old.
They did talk to Daniel's developmental pediatrician, but it was only AFTER we faxed them a second copy of documentation stating he meets the criteria for autism spectrum disorder. They never intended on speaking to any of Daniel's doctors about his healthcare needs. Now, they're suddenly interested because they are bound to cover therapy by law. I'm sooooo tired of all these antics.
Friday, August 28, 2009
There IS a Light at the End of the Tunnel
I spoke with the nurse at Daniel's developmental pediatrician's office today, and she confirmed to me that Daniel does, indeed, have an autism spectrum disorder. She faxed the information to Frank at work this afternoon; he will be forwarding that information, as well as a copy of the Illinois autism mandate, to Aetna on Monday morning.
I called Aetna's customer service number this week to find out which diagnosis codes were used in the billing for our visits with the Dev. Ped., and their representative told me what they were. She also confirmed to me that they were appropriate codes for this autism spectrum disorder diagnosis. Daniel started seeing this doctor on Oct. 30, 2008 - his 5th birthday. It was after the new legislation went into effect for us (August 2009) that Aetna denied our request for coverage for therapy. The reason we were given - we do not have coverage for this type of services. Really?!?!? According to Illinois law, we most certainly do. I'm interested to see what the outcome of our appeal will be. We do have an attorney, and he will call Aetna if necessary.
The funny thing is that I've had numerous therapists and doctors tell me not to give up because that's what Aetna wants me to do. They call it the insurance game, and that's what I was calling it before any of them ever mentioned that phrase to me. Only 2 people have tried to talk me out of continuing therapy, but I just knew that God was going to work this whole thing out somehow.
I truly believe that God directs every step we take in our lives, and it was by no accident that we decided to take Daniel to a developmental pediatrician and that we found out about the autism mandate. I posted a couple of Facebook notes about this, and I tagged a friend in the note who is an attorney who is familiar with this type of thing. She was not in my mind immediately as I was tagging people, but something kept telling me I should tag her in the note. I listened to that still, small voice, and it proved invaluable. She posted a comment on locating advocacy groups for help, and I did just that. I googled advocacy groups in NW Indiana, and I called 5 of them.
Two people called me back - one who really didn't help me and another one who had more information than I could have ever hoped to find. She's the one who pointed me in the direction of Illinois' law regarding insurance coverage for children with autism spectrum disorders. She also told me about the new legislation Gov. Quinn signed regarding coverage for children with developmental disabilities. That law takes effect on January 1, 2010, and I'm telling everyone I know about it. The more we moms of kids with special needs can help each other, the better.
It's very comforting to know that an insurance company like Aetna would seek to deny a child the only treatment for his medical condition(s) that would help him overcome it, but God will not allow such a thing to happen. One of the songs we sing at home and in church talks about how He's the Defender of the weak, and I can definitely see that in Daniel's life. Because of his sensory problems, virtually everything for him is a struggle - eating, brushing his teeth, writing his name, etc. Yet, God has brought him this far, and He's not about to let an insurance company stop what He has started in Daniel's life.
God definitely has a purpose and a plan for Daniel's life. He is amazingly sweet and kind-hearted. I truly believe that he's come such a long way in the past 3 years because we have not only made sure he has the medical care he needs, but we believe that God has much more planned for him than we can ever imagine.
"For I know the plans I have for you," declares the Lord, "plans to prosper you and not to harm you, plans to give you a hope and a future." Jeremiah 29:11
I called Aetna's customer service number this week to find out which diagnosis codes were used in the billing for our visits with the Dev. Ped., and their representative told me what they were. She also confirmed to me that they were appropriate codes for this autism spectrum disorder diagnosis. Daniel started seeing this doctor on Oct. 30, 2008 - his 5th birthday. It was after the new legislation went into effect for us (August 2009) that Aetna denied our request for coverage for therapy. The reason we were given - we do not have coverage for this type of services. Really?!?!? According to Illinois law, we most certainly do. I'm interested to see what the outcome of our appeal will be. We do have an attorney, and he will call Aetna if necessary.
The funny thing is that I've had numerous therapists and doctors tell me not to give up because that's what Aetna wants me to do. They call it the insurance game, and that's what I was calling it before any of them ever mentioned that phrase to me. Only 2 people have tried to talk me out of continuing therapy, but I just knew that God was going to work this whole thing out somehow.
I truly believe that God directs every step we take in our lives, and it was by no accident that we decided to take Daniel to a developmental pediatrician and that we found out about the autism mandate. I posted a couple of Facebook notes about this, and I tagged a friend in the note who is an attorney who is familiar with this type of thing. She was not in my mind immediately as I was tagging people, but something kept telling me I should tag her in the note. I listened to that still, small voice, and it proved invaluable. She posted a comment on locating advocacy groups for help, and I did just that. I googled advocacy groups in NW Indiana, and I called 5 of them.
Two people called me back - one who really didn't help me and another one who had more information than I could have ever hoped to find. She's the one who pointed me in the direction of Illinois' law regarding insurance coverage for children with autism spectrum disorders. She also told me about the new legislation Gov. Quinn signed regarding coverage for children with developmental disabilities. That law takes effect on January 1, 2010, and I'm telling everyone I know about it. The more we moms of kids with special needs can help each other, the better.
It's very comforting to know that an insurance company like Aetna would seek to deny a child the only treatment for his medical condition(s) that would help him overcome it, but God will not allow such a thing to happen. One of the songs we sing at home and in church talks about how He's the Defender of the weak, and I can definitely see that in Daniel's life. Because of his sensory problems, virtually everything for him is a struggle - eating, brushing his teeth, writing his name, etc. Yet, God has brought him this far, and He's not about to let an insurance company stop what He has started in Daniel's life.
God definitely has a purpose and a plan for Daniel's life. He is amazingly sweet and kind-hearted. I truly believe that he's come such a long way in the past 3 years because we have not only made sure he has the medical care he needs, but we believe that God has much more planned for him than we can ever imagine.
"For I know the plans I have for you," declares the Lord, "plans to prosper you and not to harm you, plans to give you a hope and a future." Jeremiah 29:11
Tuesday, August 25, 2009
God is Good!
I spoke with an Indiana Special Kids advocate this morning about the problems we're having with Aetna. As it turns out, the governor of Illinois recently signed a bill that requires insurance companies to provide coverage for children with developmental disabilities. That bill goes into effect on 1/1/10. All we have to do is find a way to get coverage for the 6 months prior to that, and coverage for Daniel's therapy will be covered as mandated by law. I'm sooooo glad our insurance is through a company in Illinois!
She also pointed me in the direction of an IL Senate bill that mandates coverage for autism spectrum disorders. Daniel's developmental pediatrician says that he IS on the autism spectrum. I requested copies of that documentation from her, and we will be faxing that info, as well as a copy of the IL legislation, to them ASAP. I would think that they would want to comply with Illinois law. Apparently, I am wrong. This only solidifies my complaint with the IL Insurance Commission. I will be faxing copies of all this paperwork to them as well.
She also pointed me in the direction of an IL Senate bill that mandates coverage for autism spectrum disorders. Daniel's developmental pediatrician says that he IS on the autism spectrum. I requested copies of that documentation from her, and we will be faxing that info, as well as a copy of the IL legislation, to them ASAP. I would think that they would want to comply with Illinois law. Apparently, I am wrong. This only solidifies my complaint with the IL Insurance Commission. I will be faxing copies of all this paperwork to them as well.
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