2/11/2015

Warning: Here Be Cussing. Lots of it.

Insurance.

Oh for the love of web footed friends in the forest.

Insurance.

So, the littlest one has a mild speech delay. And, pushing aside the mommy guilt (unfounded, yes, I know) that I have  because of it, I've got him in speech therapy twice a week.

Let's back up a bit, shall we? The husband's company moved locations last year, about half-way through the year. And, insurance companies being the pieces of poop that they are, decided that their current company/plan was no longer an option owing solely to the address of record for the company. They moved all of maybe ten miles, within the same state, so it's not as if they moved into DC or anything like that. But ok, fine. Whatever. They switched to another company and plan, one we'd had before and liked. But of course, we'd had it before and liked it prior to the current clown in the white house and his bend you over the barrel and stick it to you care act.

So of course, the new plan is nothing like the old plan for all they share the same name.

Now, our old insurance was pretty straight forward. They don't cover speech therapy, period, unless it's caused by medical trauma. So, I don't agree with that but whatever, it was clear. So we've been self-paying at our current place and they have a semi-reasonable self-pay option so, fine. (I'm not sure I believe that speech therapy is worth spit on a tissue, but that's a post for another day.) When we switched insurance, I took the info in because everything online said that oh, of course it's covered, X visits a year and so forth. Well, the place we're going is out of network for the new insurance.

Fine. But since we *could* have it covered, it makes sense to go somewhere that takes our company. So I find a place and get an evaluation appointment and yesterday we have the chance, finally, to go in and do that. And everything is good and I have appointments all set up and am planning to tell our current place that we're done when we go in today.

And then they call this morning to say that they've been told that developmental delays aren't covered.

But...what? All the documentation for the plan clearly spells out the coverage for speech therapy. With no mention of any exceptions that the therapy can't be because of a developmental delay. You'd think that, knowing that insurance companies want people who FREAKING PAY THEM MONEY to know how and why they are getting benefits, you'd think that they'd be very clear about the 9 zillion exceptions to any benefit that they so happily state. Of yes, of course we cover speech therapy. Unless you mean speech that comes out of a person's mouth. We don't cover *that* kind of speech therapy. We just cover therapy for talking asses. (So hey, all the people in the White House are good. It's just us little people who are hosed.)

So I call up the member services number and talk to "Mike." Now, if this person in India's name is Mike, my name is Bathsheba. But ok, fine. It's a call center. Welcome to 2015. So I wade though his horrific accent and, after clarifying that no, he's not talking to my three-year-old with a speech delay, but is, in fact, talking to his mother (really, I should have known it was going to all go bad when he asked why the boy couldn't be having this call. Um. Look at the birthdate, man, he's 3) I ask about the coverage. And he gives me the same info that's online. So I mention that the lady at the therapy center mentioned that she was told there was a Clinical Services Memo that made it un-covered. And he says, "That memo doesn't apply to the type of plan you have."

I push a little more cause I know that at the end of the day, he's just some idiot hired to answer the phone and read me the website but that he might have a little more information than the average person can get and he gets the therapy center lady on the line and she mentions a code and he says oh that diagnostic code triggers the memo.

"But the memo doesn't apply to my plan?" Isn't that what he just said?
"Well, but the code..."
"Shouldn't matter if the MEMO DOESN'T APPLY TO MY PLAN. PERIOD."

Oh, there was a misunderstanding? Oh. My bad. I misunderstood that when your lips were moving you were talking out of your ass.

But hey, at least YOU qualify for speech therapy.

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