Military Special Needs Network

Proudly Supporting all Military Families with a Special Needs Dependent

400177519

Wk3_SNRyGos_United400177519

Those nine numbers were the catalyst for a war against insurance. What started as a routine reauthorization for occupational therapy, turned into weeks of calls, denials, and errors on the part of the insurance company.

On July 30th, I received a notification that authorization number 400177519 (a request for occupational therapy) was denied due to it “not being a covered benefit.”

I figured a simple phone call would clear this up. My son has been in occupational therapy for over a year and there has never been an issue. When I spoke with a United Healthcare Military and Veterans (UHMV) representative, I was told the authorization was denied because they needed additional progress notes from the therapist. I asked if either the requesting provider or the occupational therapist were notified that additional information was needed and was told that they had not.

The office manager at my son’s occupational therapy center called UHMV to see where the progress notes needed to be sent; she was given the fax number to the Extended Care Health Option (ECHO) office. For those not familiar with military healthcare, ECHO does not cover medical therapies such as speech, occupational, or physical therapy. Because they have no authority to approve of medical therapies, ECHO denied my son’s referral.

It took over 2 weeks for my son’s progress notes to make their way from ECHO to the basic medical center. In that two weeks, 37 calls were made to UHMV. These calls were not only for the OT referral, but also for my son’s speech therapy authorization that went missing – I can see it on his online profile, but UHMV can’t see it in their system- and to fix the Applied Behavioral Analysis referral that was assigned to the speech therapist.

It wasn’t until I refused to get off the phone for over 2 hours to guarantee that it was fixed that my son’s occupational therapy authorization was approved. There is nothing that can be done for the speech referral except start from the beginning, but it is okay. I know what needs to be done for next time because I know there will be a next time.

For more Special Needs Ryan Gosling Memes this week, visit Adventures in Extreme Parenthood.

This has been Week 3 of the Special Needs Ryan Gosling link-up via Adventures in Extreme Parenthood with Sunday Stilwell. To see what other bloggers imagine RyGos might be thinking this week, visit www.ExtremeParenthood.com and feast your eyes on some RyGos eye candy.

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3 comments on “400177519

  1. gretchen
    August 16, 2013

    Oh yes, UHC and I have been in numerous battles! I had to call multiple times for them to fix an EOB and they try to transfer me to ECHO….um NO! YOU are the ones that pay so YOU have to fix it! This switch has been absolutely infuriating to say the least. My kids’ OT referrals get stuck in the cyber black hole for weeks and then I got the same thing about my son about ‘progress notes’ and then they didn’t put the proper codes on my daughter’s OT referral and then I am supposed to call the primary care doc????HE doesn’t put the codes on!!!!! GEESH!

  2. Misty @ Meet the Cottons
    August 16, 2013

    We have Humana Military and I haven’t had quite the troubles you’ve described, but one thing you mentioned caught my attention. My children receive Speech Therapy with a DX of 315.39. With that DX code on the referral, I am unable to view the referral online. Any suggestions for an alternate DX?

  3. gretchen
    August 16, 2013

    Misty, I would talk to your speech path and have them dictate what dx codes they want on the referral. It should not be up to us beneficiaries to do it.

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