Friday, May 6, 2011

Medical Necessity

Well, that whole what to do about speech therapy question might get cleared up for us after all.  Just got a call that our insurance hasn't covered any of Roo's feeding therapy since the beginning of February.  They covered it up until February "in error" and fortunately they have not asked for their money back.  Yet.

Apparently Roo's feeding therapy is neither restorative nor medically necessary and to top it off they claim he has no underlying conditions which should impair his swallowing.  Like say, eosinophilic esophagitis or the laryngeal cleft the ENT found.  Forgive me but I'm about to send my puking, gagging, failing to thrive, hour and a half to eat a decent meal kid over to their offices for a quick demo.

We're appealing the decision but at $400 a pop for weekly sessions, this isn't going to be cheap if we lose.  If you need me today I'll be busy gathering letters of medical necessity from our slew of doctors.


  1. Seriously?? It doesn't make any sense that they would cover Olivia's OT (which is a necessity for the sanity of our family, but not exactly a medical necessity), but not RAC's therapy (maybe don't mention that to them!!!)! Our experience with Cigna is that we get different answers from everyone we talk to. I'm sure you'll get the necessary 'letters' and get them to cover it, but what a hassle! And $400 a session??@!


  2. I know! I was dumbfounded. Especially when the alternative would likely be a feeding tube and medical grade formula for a period of years. That cannot possibly be any cheaper for them.

    And, thank goodness the hospital called to tell us. Cigna never even sent a letter or anything. We could have gone on like this for many more weeks before knowing it wasn't covered.

    We are working on it from all ends. Fingers crossed.