Hi! I have a 20 month old son who was recently diagnosed with Fragile X Syndrome. It causes cognitive and learning delays, extreme anxiety, often ADHD, and many behavioral challenges similar to autism. He will need support for the rest of his life. He has been receiving weekly Physical Therapy, Occupational Therapy, and Speech Therapy, and has made tremendous progress. He is now out of OT and PT hours and I’m being told this is a hard limit and there is no way to get around it. How can this be?! He especially needs PT as he cannot walk yet and has orthotics. I did call to check our session limits at the beginning of the year and was told he had unlimited therapies, but I had BCBS TX pull up the notes and they are showing they only told me his speech was unlimited. I was told even if they did misquote me, they would only honor it up until they told me the correct info. I am currently putting together an appeal, but what else can we do? We are willing file complaints or hire an attorney if necessary (assuming it makes fiscal sense). We are paying about $230 a week out of pocket currently to continue these therapies because a) my son really needs them and b) we cannot risk losing our time slot or therapists at the center.
And to open up an even bigger can of worms, we need to figure out an insurance plan for next year that will provide him with weekly private therapy. We are currently on COBRA and can continue through the end of 2022 but I’m not sure if that’s our best option now that I know it doesn’t cover everything we need. Our family of 4 currently pays $1500/month premium for a $5k individual/$10k family high deductible plan. We are in TX and do not qualify for Obamacare subsidies, Medicaid buy-in, or any other assistance as far as I can tell. My husband works for a very small family business and is currently the only employee who needs/wants insurance through the company. I can potentially pick up some shifts to be added to the payroll too if needed. We have the authority to chose whatever plan we want, but I’m not sure if we’d even qualify for small business plans in this situation.
submitted by /u/Bhen2727
[link] [comments]Hi! I have a 20 month old son who was recently diagnosed with Fragile X Syndrome. It causes cognitive and learning delays, extreme anxiety, often ADHD, and many behavioral challenges similar to autism. He will need support for the rest of his life. He has been receiving weekly Physical Therapy, Occupational Therapy, and Speech Therapy, and has made tremendous progress. He is now out of OT and PT hours and I’m being told this is a hard limit and there is no way to get around it. How can this be?! He especially needs PT as he cannot walk yet and has orthotics. I did call to check our session limits at the beginning of the year and was told he had unlimited therapies, but I had BCBS TX pull up the notes and they are showing they only told me his speech was unlimited. I was told even if they did misquote me, they would only honor it up until they told me the correct info. I am currently putting together an appeal, but what else can we do? We are willing file complaints or hire an attorney if necessary (assuming it makes fiscal sense). We are paying about $230 a week out of pocket currently to continue these therapies because a) my son really needs them and b) we cannot risk losing our time slot or therapists at the center. And to open up an even bigger can of worms, we need to figure out an insurance plan for next year that will provide him with weekly private therapy. We are currently on COBRA and can continue through the end of 2022 but I’m not sure if that’s our best option now that I know it doesn’t cover everything we need. Our family of 4 currently pays $1500/month premium for a $5k individual/$10k family high deductible plan. We are in TX and do not qualify for Obamacare subsidies, Medicaid buy-in, or any other assistance as far as I can tell. My husband works for a very small family business and is currently the only employee who needs/wants insurance through the company. I can potentially pick up some shifts to be added to the payroll too if needed. We have the authority to chose whatever plan we want, but I’m not sure if we’d even qualify for small business plans in this situation. submitted by /u/Bhen2727 [link] [comments]Read Morer/HealthInsurance