As you will see from Tim's response below, he told me what the representative on the phone already told me--so in fact the only thing he did was waste more of my time. I understand he was doing his job and following the standard operating procedures established by executives whose bonuses could pay for Caroline's therapy for a year, but still I am frustrated.
Tim's response:
Hello Kacie,
Thank you for taking to the time to e-mail me your information. I was able to research your account this evening and unfortunately I do have some bad news. Since you are an OAP member with in and out of network benefits we are unable to complete a network adequacy appeal. I know this is not the answer you were looking for and I tried to see if there was anything I could do internally, however this is a standard operating procedure for PPO and OAP plans in relation to ancillary services. I am truly sorry for the inconvenience this has caused you and your family and I hope that in the future we can establish a broader network of speech therapist in your area. I know that I wasn't able to give you the answers you were looking for with this issue, but if there is anything that I can do to help you in the future please feel free to email me. I wish you and Caroline the best of luck and hope you enjoy the rest of your week.
Tim
Please like this post if you are frustrated with insurance companies.
hi, not to be nosey really but im wondering (after reading a couple of your posts regarding cigna which is also my primary insurance company and i have 4 kids with various special needs and cigna sucks) if there is the equivalent of new york state medicaid that you could apply for for your beautiful daughter? here in ny i was able (with tremendous difficulty, many months, tons and tons of paper trail type work) able to obtain medicaid without the state looking at my income (which really isnt alot - im an RN, work full time, make about 90,000 per year) which i was then able to move to whats called medicaid waiver programs for the kids . so these medicaid waiver programs enable me to access services that cigna will not even consider ( like aba, speech therapy , social skills groups, certain equipment like a special needs bicycle for one of my kids, a specialized swing for another ) . im not sure if every state has this type of state insurance but if you could look into it through your local department of social services i think it would be so good... best of everything to you and your family. anne in ny
ReplyDeleteHi Anne,
ReplyDeleteThanks for taking the time comment and to inquire about Caroline's eligibility for various waivers.I am actually working on applying for several waivers right now which could help with many of our medical expenses, if Caroline is considered eligible. As you mentioned the criteria changes from state to state so it is a challenge. In addition to waivers, in Ohio there is a grant for anyone who is diagnosed with autism to use toward education not received in a public school so we are also going to exercise that option.