bkweavers Posted September 17, 2010 Report Share Posted September 17, 2010 Wondering if anyone can give me any advice to help. My daughter has had POTS for almost 3 and 1/2 yrs. and has had physical therapy for almost 3 yrs. This past summer we switched therapists in order to have her start different therapy - vestibular therapy. She worked her tail off this summer and in 3 months time, has made tremendous progress. Now that we're finally seeing some improvement in her, out of the blue, our insurance company decides to deny any more therapy. We were told a pediatric neurologist looked over her files and decided she didn't need therapy anymore! We are fighting this and my wonderful, level-headed husband already called the insur. company to talk to them. He requested that they talk to my daughter's neurologist, who also happens to be a autonomic specialist. He also caught the woman in a few lies along the way, but that's another whole topic!Anyway, we've talked to her doctor who is willing to go to bat for us and I've talked to her school therapist, who is also willing to help. Our daughter basically was horizontal for 2 and 1/2 years. She is finally able to sit up all day. She cannot walk without the aid of someone. She still is dizzy/lightheaded while sitting up. Obviously, she is not completely better!!I'm sure many of you have dealt with this and I'm really hoping I hear some good outcomes and advice on this. We could also use prayers! Boy, do we need to do something about the insurance companies in this country! Quote Link to comment Share on other sites More sharing options...
comfortzone Posted September 17, 2010 Report Share Posted September 17, 2010 You most certainly have my prayers.... I bet the appeal will win out and you will come out of this okay.... Till then hang in there...stay focused...& remember if one door closes another surely opens... Blessings to you! (Sounds like you've come a long way ... keep moving forward...always forward -- YES use your docs to go to bat for you big time!) Quote Link to comment Share on other sites More sharing options...
houswoea Posted September 17, 2010 Report Share Posted September 17, 2010 I am sure this will work out! It would be a crime to deny this to your child, silly insurance people! You should ask them how they would feel if they couldn't walk on their own! Quote Link to comment Share on other sites More sharing options...
issie Posted September 17, 2010 Report Share Posted September 17, 2010 Keep on top of the insurance company. They want you to give up. If need be, send info from all the doctors and letters. Appeal, appeal, appeal. It takes alot of preserverance. They want you to get tired and give up - DON'T!!!!! I do know, however - that most insurance companies have only so many PT visits per year that are allowed by the plan. If those visits are used up - I'm not sure they can legally be required to give you more. Check your plan benefits and see if you are entitled to more. Then if you are - do the above. Hoping for the best!!!!!!!!! Quote Link to comment Share on other sites More sharing options...
bkweavers Posted September 22, 2010 Author Report Share Posted September 22, 2010 Thanks everyone for the encouraging words! Yesterday, we found out that the insur. company is approving my daughter for 9 more sessions of therapy! I'm soooo happy! I really thought we were in for a fight after talking to other people who have a cap on the amount of therapy they can receive in a year. Liz's wonderful POTS doctor talked to the doctor at the insurance company and whatever he said, must have convinced the doctor to put his stamp of approval on it. After the 9 weeks, they'll talk to Liz's doctor again for an update and she'll have to see him and we'll go from there.I guess you can win with insurance companies, at least sometimes.Brenda Quote Link to comment Share on other sites More sharing options...
juliegee Posted September 22, 2010 Report Share Posted September 22, 2010 Thanks everyone for the encouraging words! Yesterday, we found out that the insur. company is approving my daughter for 9 more sessions of therapy! I'm soooo happy! I really thought we were in for a fight after talking to other people who have a cap on the amount of therapy they can receive in a year. Liz's wonderful POTS doctor talked to the doctor at the insurance company and whatever he said, must have convinced the doctor to put his stamp of approval on it. After the 9 weeks, they'll talk to Liz's doctor again for an update and she'll have to see him and we'll go from there.I guess you can win with insurance companies, at least sometimes.BrendaYay! And good for you for finding a type of therapy that's helping! We have had to make insurance company appeals in the past on behalf of our son- so much perseverance & work. It also brings out the Mama Grizzly in me and makes me quite emotional- which doesn't help You certainly did the right thing by having your daughter's doctor speak to the insurance company. Another tactic we found that was helpful (if you face this in the future) was to send a really basic (not wordy) letter- stating the problem & pleading your case stapled to a large 5"X7" picture of your child. Makes the appeal more real. Congrats!!! So happy for you all-Julie Quote Link to comment Share on other sites More sharing options...
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