After nearly two years of learning about all of these fields, I didn't think I would be taking on any more new jobs pertaining to the care of my twins. I was wrong. My latest job description that no one in the NICU forewarned me about is that of medical coding specialist. The speech therapy office called me on Friday to let me know that ALL of Camdyn's speech therapy visits from Sept.-Dec. of 2011 and ALL of her speech therapy visits so far in 2012 have been denied by our insurace. What?!? Our phone conversation went something like this:
"Are you telling me I owe you over $2000?"
"Yes, ma'am. Whatever your insurance doesn't pay, you are responsible for."
"And, why couldn't you tell me this 15 visits ago, as in last year sometime?!"
"Well, I was on maternity leave and someone else was handling your account."
That's not my problem, and I wouldn't call 15 denied visits handling my account. (what I'm thinking)
After 3 calls to my insurance company, the first 2 of which I was disconnected, I finally spoke with someone who could shed some light on the situation. This was only after I began yelling at that stupid automated voice. It's pretty funny, albeit aggravating, to yell at the automated voice. She responds, "I didn't understand your response. Please say what you are calling about." I suppose it's better to take out my frustrations on the automated voice than a real person. When I finally spoke to someone with a brain, she helpfully figured out that code 315.3 which means expressive speech delay is not covered by my plan; however, code 781.3 which means lack of coordination is covered under the plan. I thanked her and then sent a message to the therapy place reporting my finding. I have no idea why this was my job to do at all. Why couldn't the medical billing people at the therapy office figure this out on their own?
Aside from the frustration at people not doing their job and me having to do it for them, I don't understand why therapy wouldn't be automatically covered for micro-preemies anyway. It's not hard to believe that a child who was born like this might need a little help:
Maybe I should just send them this picture. It's frustrating that I even have to fight at all to get them the help they need . Since Cade has Medicaid right now from having a g-tube, he gets all the services he needs. Camdyn, on the other hand, is only covered under our insurance plan. Health care needs huge reform. Does it make any sense that Cade qualifies for as many therapy visits as he needs, but Camdyn can only receive 20 speech therapy visits per calendar year because that's what our insurance has decided she needs and then I have to prove that she needs those? One of the first two insurance reps I spoke to told me she had to be diagnosed with a "congenital abnormality." Well, I wouldn't define being born at only one pound and needing a ventilator for 5 weeks to breathe as "normal".
Hopefully, we (as in mostly me) will get this all sorted out soon so she can continue with her speech therapy. She is making great progress.