Lies from Doctor's office

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Our son was not talking much by the age of 3, and his Pediatrist suggested to try a speech therapist. We sought referrals, and after making sure the therapist's practice accepted our insurance plan, we chose a speech therapist (ST) close to our home. Before beginning the therapy, we had the ST confirm that the therapy sessions would be covered by our insurance. ST informed us that insurance would cover 30 sessions each year, and since we have a high deductible plan, we would have to pay for the sessions till the deductible was met. We called up insurance company to verify, and were told that 30 therapy sessions are indeed covered, as long as therapy is necessary.

So our son started undergoing therapy, and over a months time, we paid for the first 5 sessions out of pocket ($700). We kept following up with ST's office to file for insurance first (so as to meet our deductible), but ST kept delaying, and filed late. After the first 5 sessions, we put the therapy on hold till we got confirmation from our insurance company. Lo and behold, the insurance company rejected all the claims. Turns out, the insurance company only pays for ST if it is required as part of rehabilitation after an accident or trauma - neither of which was applicable in our case. The ST now claims that each insurance plan is different, and their office only checked online to see if the therapy would be covered.

ST doesn't want to talk with us on this matter now. I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits) - however, this was all verbal communication, and nothing in writing.

I can file for chargeback on the credit card, but I suspect ST would then send this into collections. Should I just eat think of it as a $700 lesson to not trust doctor's offices? Sue them (not sure if it would even be worth it)? Any ideas on what my options are?

TIA!

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Not sure on the 'insurance part'. Doesn't your local school district cover something like this?

School districts usually give 1 hour per week of ST at best

Your issue is between you and the insurance company.

"We called up insurance company to verify, and were told that 30 therapy sessions are indeed covered, as long as therapy is necessary."

Your insurance company told you that its covered. The ST believed it was covered too. Same as you.

Apparently its not really covered. Because... the insurance company / plan details says so.

If you called the insurance yourself and you were told it is covered and then the ST also thought it was covered, why are you deciding that the ST is a liar?

This situation sucks. Insurance plans are often a night mare to navigate.

Every individual provider I'm dealing with has difficulty even submitting claims to the insurance. Yes they deal with literally 1000's of different plans and they have no idea how each of them works. (at least thats what I'm told by individuals more than once and it seems evident in what happens in their billing)

The ST performed 700 worth of service and you owe them for that service. IMHO if you have a complaint its with your insurance for telling you and the ST it was covered when it apparently isn't.

Public service announcement:

GET INSURNACE PRE-APPROVAL IN WRITING

Oh, 1 hour a week, yeah that's usually true.

But I wonder if the ST really did verify insurance, (like every other kind of doctors office) and just told them that to get them in the door, if so then the ST would be on the hook for the 5 sessions, not OP.

Basically OP is going to have to fight the ST to get the sessions approved OR get those fees waived.

I've had something similar happen before. There are different codes to submit for the same therapy. As you found out your health insurance only covers certain codes. You say your ST isn't talking to you anymore, why is that? Did you go in person?

Ask the ST for their cash discount price.  They never expected to be paid the full $700 by anyone.  You should aim for a 50% discount for having paid cash and for the 'misunderstanding' about your ins coverage.

Ask them what your ins co would have paid them had you been covered and ask them to accept the same amount from you instead of your ins co.

OP - my input, not insurance related by the speech condition related.  Is your son shy/quiet in front of strangers or outside of the house?  If so, you may want to look into a condition called "Selective Mutism".  One of my boys has this condition where he is absolutely unable to speak with ANYONE once outside the comfort of the home.  Not with his friends, his teachers, his cousins/siblings or with me.  Once outside of the house, the only way he communicates is through gestures, hand signals or nodding his head.  We tried therapies but they're not helping and don't want to put him on the meds yet (too young).  One silver lining: since he doesn't care to talk with his classmates in the schools, he concentrates in the classroom so he gets all A's and B's in his report cards.

Appeal with the insurance or complain to your HR Dept/Benefit coordinator. Claims are often a mess now.

FaxMac said:   Our son was not talking much by the age of 3, and his Pediatrist suggested to try a speech therapist. We sought referrals, and after making sure the therapist's practice accepted our insurance plan, we chose a speech therapist (ST) close to our home. Before beginning the therapy, we had the ST confirm that the therapy sessions would be covered by our insurance. ST informed us that insurance would cover 30 sessions each year, and since we have a high deductible plan, we would have to pay for the sessions till the deductible was met. We called up insurance company to verify, and were told that 30 therapy sessions are indeed covered, as long as therapy is necessary.

So our son started undergoing therapy, and over a months time, we paid for the first 5 sessions out of pocket ($700). We kept following up with ST's office to file for insurance first (so as to meet our deductible), but ST kept delaying, and filed late. After the first 5 sessions, we put the therapy on hold till we got confirmation from our insurance company. Lo and behold, the insurance company rejected all the claims. Turns out, the insurance company only pays for ST if it is required as part of rehabilitation after an accident or trauma - neither of which was applicable in our case. The ST now claims that each insurance plan is different, and their office only checked online to see if the therapy would be covered.

ST doesn't want to talk with us on this matter now. I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits) - however, this was all verbal communication, and nothing in writing.

I can file for chargeback on the credit card, but I suspect ST would then send this into collections. Should I just eat think of it as a $700 lesson to not trust doctor's offices? Sue them (not sure if it would even be worth it)? Any ideas on what my options are?

TIA!
 

The tow highlighted statements are not the same.  What does the written insurance plan say. Not the summary of benefits but the detailed insurance coverage document.
If it says the latter, you got incorrect or incomplete information from insurance when you spoke with them first.
If it says the former, they are incorrectly denying the claim. It is also possible that the doctor's office did not use the right codes to indicate this therapy was "necessary".

In any case, the blame largely lies with insurance and not so much with the doctor's office. Perhaps could be on you as well in terms of not understanding or recollecting what insurance told you in your first conversation.

A couple of things (in no particular order).

1. $140 per session (hour?) is on the very high side. Medicare/Medicaid will only pay about $70-75 per hour session.
2. Insurance benefits for speech is very confusing. If there is not a 'medical' diagnosis, then it's considered a mental health benefit which many plans with speech benefits don't cover.
3. Was there an Evaluation? If so, what was the diagnosis (ICD10 code)? A proper evaluation should take 2-4 hours contact time and result in a lengthy report. An Evaluation is needed to develop a Treatment Plan. Get the report as soon as possible before the relations with the therapist break down further.
4. Was there a treatment plan? A treatment plan is needed for the therapist to know what to work on in each session. If there is a treatment plan, get a copy as soon as possible.
5. Get the session notes as soon as possible.

None of this is medical advice.

Before Age 3, most state Early Intervention Programs will cover an evaluation at no cost to the family. After Age 3, most states will have options to get the eval through the school system.

Two key benefits of coordinating your services through a state program is the programs will limit charges to medicare/medicaid rates and enforce the Evaluation/Treatment Plan/Session Note documentation requirements.

fwuser12 said:   
FaxMac said:   Our son was not talking much by the age of 3, and his Pediatrist suggested to try a speech therapist. We sought referrals, and after making sure the therapist's practice accepted our insurance plan, we chose a speech therapist (ST) close to our home. Before beginning the therapy, we had the ST confirm that the therapy sessions would be covered by our insurance. ST informed us that insurance would cover 30 sessions each year, and since we have a high deductible plan, we would have to pay for the sessions till the deductible was met. We called up insurance company to verify, and were told that 30 therapy sessions are indeed covered, as long as therapy is necessary.

So our son started undergoing therapy, and over a months time, we paid for the first 5 sessions out of pocket ($700). We kept following up with ST's office to file for insurance first (so as to meet our deductible), but ST kept delaying, and filed late. After the first 5 sessions, we put the therapy on hold till we got confirmation from our insurance company. Lo and behold, the insurance company rejected all the claims. Turns out, the insurance company only pays for ST if it is required as part of rehabilitation after an accident or trauma - neither of which was applicable in our case. The ST now claims that each insurance plan is different, and their office only checked online to see if the therapy would be covered.

ST doesn't want to talk with us on this matter now. I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits) - however, this was all verbal communication, and nothing in writing.

I can file for chargeback on the credit card, but I suspect ST would then send this into collections. Should I just eat think of it as a $700 lesson to not trust doctor's offices? Sue them (not sure if it would even be worth it)? Any ideas on what my options are?

TIA!

The tow highlighted statements are not the same.  What does the written insurance plan say. Not the summary of benefits but the detailed insurance coverage document.
If it says the latter, you got incorrect or incomplete information from insurance when you spoke with them first.
If it says the former, they are incorrectly denying the claim. It is also possible that the doctor's office did not use the right codes to indicate this therapy was "necessary".

In any case, the blame largely lies with insurance and not so much with the doctor's office. Perhaps could be on you as well in terms of not understanding or recollecting what insurance told you in your first conversation.

  

If it's a UnitedHealthCare company, then the language is probably confusing to the average person.  Nevertheless, OP should get the Summary Plan Document (100+ pages) and verify that they indeed don't have coverage for speech services with a mental health diagnosis.  Very often (especially UHC owned companies) will verbally say speech services are covered when in fact they are not.  

That said, this is a very well known issue for speech therapy services.  The Therapist or their office very much knows this and should have properly verified it before starting services.

Shame on the pediatrician and the SLP for not giving you the information that gatzdon provided. Pursue having the school system provide SLP services. I understand fleetwoodmac's concern about limited hours but that's not a fact in every situation.

ZenNUTS said:   Public service announcement:

GET INSURNACE PRE-APPROVAL IN WRITING

  My insurance told me that a hospital was in network and so, I demanded a letter stating this. Afterwards, I received a very large bill and when I questioned the insurance, I was told the hospital is not in network. I told the rep that a previous rep told me that it was in network. She said she could only honor it if I had it in writing. I sent it to her and this saved me $40,000. One letter = $40,000. The healthcare system is broken. 

OP, I don't know what state you live in, but in NY therapies (speech, occupational, physical) are paid for by the state or school districts is the child tests with a certain percent delay. It's through the Early Intervention/CPSE programs. I thought most states had a similar program, but maybe not. Did your child have any initial testing to confirm a delay?

FaxMac said:   since we have a high deductible plan, we would have to pay for the sessions till the deductible was met.
I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits)

  Those are confusing statements. If the first visits total $700, and that is certainly below your deductible, insurance will not cover these visits. The cost of the visits have to total your deductible, before insurance would kick in on subsequent visits. 

atikovi said:   
FaxMac said:   since we have a high deductible plan, we would have to pay for the sessions till the deductible was met.
I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits)

  Those are confusing statements. If the first visits total $700, and that is certainly below your deductible, insurance will not cover these visits. The cost of the visits have to total your deductible, before insurance would kick in on subsequent visits. 

He wants the $700 to be credited as insurance deductible paid. Right now, the $700 is just an agreement/payment between the OP and ST. 

The only thing you "lost" is having the $700 apply to your deductible. You would've been out of pocket $700 anyways.

anthonyu said:   
atikovi said:   
FaxMac said:   since we have a high deductible plan, we would have to pay for the sessions till the deductible was met.
I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits)

  Those are confusing statements. If the first visits total $700, and that is certainly below your deductible, insurance will not cover these visits. The cost of the visits have to total your deductible, before insurance would kick in on subsequent visits. 

He wants the $700 to be credited as insurance deductible paid. Right now, the $700 is just an agreement/payment between the OP and ST. 

  Not trying to argue, but then he would have said, "we were told the $700 we already paid would be applied towards the deductible" and not, "we were told that the insurance would cover these visits."

I would do a couple of things:

First, find out what the diagnosis and CPT codes are.

Second, look at your health insurance plan to see what the the covered benefits are and what the medical general exclusions are. Sometimes plans are vague and/or benefits aren't correctly applied.

Third, call your health insurance and ask the representative if s/he could look up to see if the therapy is covered based on the diagnosis and CPT codes. Sometimes you get a different answer.

Fourth, you have a couple of options:

  • Negotiate yourself - ask if the ST as a charity care policy (ask for eligibility), a cash discount price (in my opinion, you have the best leverage here if you're willing to pay the entire balance off immediately), or a payment plan (if you can't front the money up front).
  • If you don't feel comfortable or don't know how to negotiate, hire a company to negotiate your bill on you behalf. One such company stated in a Consumer Reports article is Medical Cost Advocate, Inc.
  • File an appeal with the insurance company - get a copy of the letter of medical necessity from the pediatrician. There is is probably an electronic trail for the information that was verbal, but not written - ask for a copy or get details of the account notes from the insurance company when you called, and ask the ST to give you details or the notes from what s/he found out when s/he looked it up online and/or called your insurance company.

Fifth, file a grievance/complaint with your health insurance company, with your state's speech and hearing board, and/or the Better Business Bureau (BBB).

Delete.

Chill99 said:   The only thing you "lost" is having the $700 apply to your deductible. You would've been out of pocket $700 anyways.
Not necessarily.  In my experience, the amount billed is generally larger than the allowable amount.  If the claim was denied, the patient would be responsible for the amount billed, and it wouldn't apply toward the deductible.  If the claim was accepted, the patient would be responsibly for the allowable amount which is the contracted rate.  Given that OP has a high deductible plan, that amount would go toward the deductible.

Years ago my daughter was not talking at about that age and a specialist discovered a little flap or growth on or by the voice box. Had minor surgery on it and she made up for lost time quickly.
Could not shut her up. LOL

Unfortunately, I've learned the hard way that you can't trust doctors/dentists if they say something is covered by your insurance. My insurance companies have said I need to check with them first. In just about every case, it was not something easy to research. You usually take their word for it and move forward.

If the $700 is part of your deductible, I wouldn't bother getting that back. However, I wouldn't pay any more bills. If your insurance company ever told you that it would be covered, I would submit appeal and/or contact state insurance regulator. A more important part is to try to get speech therapist through your public school system. If necessary, you can get an IEP.

Not to snipe at the OP, but the one thing I've learned from all these "what do you mean it's not covered?" threads here, is that you have to trust no one but the insurer on coverage, doing the legwork yourself and preferably in writing or on a recorded line, makes me sad it has to be like this.

riznick said:   Unfortunately, I've learned the hard way that you can't trust doctors/dentists if they say something is covered by your insurance. My insurance companies have said I need to check with them first. In just about every case, it was not something easy to research. You usually take their word for it and move forward.
  This. And especially with narrow ACA exchange networks, Providers are quick to say "oh, yes we take Humana, etc" but are generalizing without realizing that my plan deliberately only covers a smaller subset.

samko said:   
ZenNUTS said:   Public service announcement:

GET INSURNACE PRE-APPROVAL IN WRITING

  My insurance told me that a hospital was in network and so, I demanded a letter stating this. Afterwards, I received a very large bill and when I questioned the insurance, I was told the hospital is not in network. I told the rep that a previous rep told me that it was in network. She said she could only honor it if I had it in writing. I sent it to her and this saved me $40,000. One letter = $40,000. The healthcare system is broken. 

  
It's a good idea. But I also think if too many people start doing it, the insurance company will just issue a policy that they refuse to confirm anything in writing.

 

This is at least how it went for my daughter in NY ... her pediatrician contacted the county's "Early Intervention" program because she wasn't talking at 3 either (the final diagnosis was childhood apraxia of speech). Early Intervention worked with us to get tested and then arranged for a variety of therapy programs (including speech therapy) in conjunction with the school district's CPSE (Committee on Preschool Special Education). EI/CPSE covered her therapy (speech was 2-3 times per week for an hour each) until she went into Kindergarten.

Once in kindergarten the school district took over the therapy full time under the CSE (Committee on Special Education). Shes had speech therapy via the school as often as daily depending on the time (shes currently in 7th grade and receiving speech 3 times a week). Its all done via an IEP (Individualized Education Plan) and there are very clear milestones, testing plans and reviews. Its a good system.

Also for what its worth my health insurance, while generally good, would not have covered her speech therapy either. Since its considered a disability the school districts have to cover it ... they will try bill anyone they can to get some of the cost back (insurance, medicaid, etc) but thats it, otherwise its just covered by what we pay in taxes. OP, I hope this might help a little moving forward ... I've had more than a few medical bills that insurance was supposed to cover that I have paid myself as well, it sucks.

jerosen said:   "We called up insurance company to verify, and were told that 30 therapy sessions are indeed covered, as long as therapy is necessary."

Your insurance company told you that its covered. The ST believed it was covered too. Same as you.

Apparently its not really covered. Because... the insurance company / plan details says so.

If you called the insurance yourself and you were told it is covered and then the ST also thought it was covered, why are you deciding that the ST is a liar?

This situation sucks. Insurance plans are often a night mare to navigate.

Every individual provider I'm dealing with has difficulty even submitting claims to the insurance. Yes they deal with literally 1000's of different plans and they have no idea how each of them works. (at least thats what I'm told by individuals more than once and it seems evident in what happens in their billing)

The ST performed 700 worth of service and you owe them for that service. IMHO if you have a complaint its with your insurance for telling you and the ST it was covered when it apparently isn't.

  you're naive.

here's how the scam went down.

ST knew "each plan is different" BEFORE rendering services (Do you really think that, after rendering services, ST suddenly discovered that insurance companies issue DIFFERENT policies with DIFFERENT coverage?).  if ST had dealt with insurance companies more that a few times, then it knew that CSRs are notorious for giving WRONG information (due to idiocy, laziness or both.   they are obviously NOT to be trusted. additionally, a physician even wrote in this thread that ST coverage is TRICKY.  how could ST have NOT known that? and how come ST FAILED to mention as much to OP?)

put yourself in ST's place.  if you wanted to get $$$$ (as in TWICE what Medicare/Medicaid pays for your services), would you tell your client that what he wanted would probably get denied?  or would you simply play along so you could extract as much $$$$ as possible out of him and ultimately blame a third party? that's what ST did.  and that's what I'd have done to.

(incidentally, you and 20+ posters are putting blame EXACTLY where ST figured you'd put it.  hook, line, sinker).

unfortunately, I've seen similar scams pulled on family members. they no longer agree to any medical/quasi-medical services until WRITTEN approval from an insurance company is in hand.  without WRITTEN approval, insurance companies will say you were NOT told X was covered.  then, after playing stupid, your provider will potentially ruin your credit by sending your bill to a collections agency.

it's a great racket.

atikovi said:   
FaxMac said:   since we have a high deductible plan, we would have to pay for the sessions till the deductible was met.
I was hoping we all could come to some agreement over the $700 that we have already paid (as we were told clearly insurance would cover these visits)

  Those are confusing statements. If the first visits total $700, and that is certainly below your deductible, insurance will not cover these visits. The cost of the visits have to total your deductible, before insurance would kick in on subsequent visits. 

  Check out ehealthinsurance. They have a great explanation of copays, coinsurance, deductibles, OOP, etc. 

clangle said:   OP, I don't know what state you live in, but in NY therapies (speech, occupational, physical) are paid for by the state or school districts is the child tests with a certain percent delay. It's through the Early Intervention/CPSE programs. I thought most states had a similar program, but maybe not. Did your child have any initial testing to confirm a delay?
  The name and implementation varies by state but the Individuals with Disabilities Education Act is Federal law that provides for/requires these services.

Chill99 said:   The only thing you "lost" is having the $700 apply to your deductible. You would've been out of pocket $700 anyways.
  Presumably the OP uses the doctors enough to meet the deductible. Now he will have to pay an extra $700 out of pocket.

In my state, schools are only required to provide speech therapy that creates a disability. The district decided that a student isn't disabled if they are still passing their tests.
Our school therapist say my daughter definitely has a speech deficiency, but won't even spend an hour to do a full evaluation  because her grades are still good.

If you aren't going to make the school fail then its just "Test them and move them down the line."

novocane said:   It's a good idea. But I also think if too many people start doing it, the insurance company will just issue a policy that they refuse to confirm anything in writing.

 

  It's not my impression that getting pre-approval is some exotic practice.  All the doctor/dentist I see insist on getting pre-approval in writing and insurance co expects it.  

There was one instance where a small outfit I saw that doesn't do pre-approval but they also made it crystal clear that it's on the patient to make sure the insurance is taken care of.  They do that by simply stating "WE DO NOT ACCEPT HEALTH INSURANCE." period.  It doesn't mean your insurance won't pay for it but it's on the patient to submit and get reimbursed.  Problem solved.

This is also why I don't accept the doctor's office's excuse that it's not their problem.  It is their problem, at least partially to clearly communicate with patient on how their practice handles insurance.

lobukox said:     you're naive.

here's how the scam went down.

...

it's a great racket.

  

Anything is possible.   Its certainly possible that the speech therapist is a crook ripping off childrens families.    But I highly doubt that is the likely explanation here.
I think its significantly more likely the insurance company doesn't have their act together and insurance benefits are stupidly difficult to determine and OP simply got misinformation.

I think you're naive to think that speech therapists conspiring to scam people is more common than ridiculously bureaucratic and inefficient and profit driven insurers misstating benefits.
 

gtstinger said:   In my state, schools are only required to provide speech therapy that creates a disability. The district decided that a student isn't disabled if they are still passing their tests.
Our school therapist say my daughter definitely has a speech deficiency, but won't even spend an hour to do a full evaluation  because her grades are still good.

If you aren't going to make the school fail then its just "Test them and move them down the line."


Passing grades doesn't define disability.   This doesn't sound right and is possibly illegal.   IANAL
  
Do you have a medical diagnosis of disability?
Do you have something in writing from the therapist that there is a deficiency?    

 

Skipping 14 Messages...
wtfu said:   
ZenNUTS said:   Public service announcement:

GET INSURNACE PRE-APPROVAL IN WRITING

  Is it really you ZenNUTS? Just need to verify its you after you were burglarized. Did they catch any suspect?

  he updated his burglary thread sometime ago.  

cliffnotes: Zen's wife signed-up for a Citi card, earning a free Iphone after buying $2k in gift cards at drug stores.  After 15 days, she  switched from AT&T to FreedomPop, enjoying 200 free minutes/month.  Sometime after downloading Tinder, she met a guy named Tyrone,

After meeting Tyrone several times at various hotels (paid for with sign-up bonuses), Mrs. Zen invited him over to her house for an afternoon hook up on a new, memory-form bed, which she had found online for 50% off. During post-coital Bliss, Mrs. Zen casually bragged about how she and Zen had made a lot of money from credit cards, purchasing gift cards and then using them to buy money orders.  Unfortunately, Mrs. Zen also mentioned that she and Zen would be out of town on such-and-such dates for a vacation paid for with points earned from both American Airlines & Marriott CC promotions.

Tyrone subsequently returned to Zen's house, cleaning it out real good.  At some point, Tyrone found dozens of Visa/MasterCard gift cards, with their PINs conveniently written on  backs of all the cards.  At first, Tyrone thought about cashing them in for money orders.  But that would get his face caught on surveillance cameras.  And, while Mrs. Zen was going on and on about her "manufactured spending" stories, she had said something about MO purchases being declined as of late,

As a result, Tyrone took the gift cards to several ATM's, ultimately withdrawing $20-$30k in cash.  

Now undercover cops follow him everywhere.  Then they stare at him, while holding large, black cell phones to ear.  When that's not happening, cops dangle teen decoys in front of him.

Currently, cops let Tyrone drive 100+ MPH, through rain, sleet & snow, hoping he'll go insane, fall for a sex sting or crash & die.



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