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Wednesday, April 27, 2011

Trust your gut

I pride myself at having a pretty good gut, and no, not one formed by eating too many marshmellow/caramel easter eggs, but one that helps me to know when something is off with one of my kids. It comes into play a lot with Elise and diabetes.

If you remember this post, in which I was very skeptical of a diagnosis of Sensory Integration Disorder with Mattias, my Mom-tuition was screaming at me.

Today, we had an appointment with another speech therapist at another clinic, and I was blown away by the difference in the two evaluations. And guess what? This therapist concluded that Mattias is a normal, active, bright, THRIVING little 7 month old. Who DOES NOT need intensive therapy 3 times a week, thankyouverymuch.

Unfortunately, finding this out came at a huge expense to us, because our insurance would not cover another evaluation. We are going to file an appeal with our insurance, and if anyone has some tips for us about this process, please send them our way.


Now... time to go and reward my gut for being so vigilant with some chocolate.

12 comments:

  1. I am SO GLAD to hear this good news! Although, the title of your post scared the heck out of me. No advice on dealing with insurance, except to fight, fight, fight it! Keep us posted on how all that turns out. Glad you received some good news, sorry you had to go through all that...you so deserve the chocolate reward!

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  2. So, insurance won't pay for the second opinion - but if you hadn't gotten it, they'd be paying for all that therapy that isn't needed.
    ??%%##!
    I'm happy and relieved that your diagnosis is the correct one. But then, we knew you were right, all along.
    Enjoy the chocolates!

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  3. Oh, good!!! Some chocolatey yumminess is totally deserved!!

    I would suggest having the second therapist write a letter to go along with your appeal. We ran into an issue when Bean was dx-ed because we were told to go the 'other' hospital, the one with the Children's Hospital, instead of the one our insurance prefers. The referring pediatrician wrote a letter explaining why and it really helped with our appeal.
    Good Luck!!

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  4. Go feed your awesomeness known as your "gut" Jo!!! This is great news and I am so happy for you guys...AND...bummer on the insurance. Good luck in getting the appeal.

    xoxo

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  5. Just want to tell you I think it's great that you figured out the first "therapist" was off. Some people want to accept everything they hear. I think you know when something sounds right and when it doesn't -- and from the description you gave of the original visit with the therapist, everything that freaked out your son would have freaked out my daughter, too.

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  6. Good news!
    My advice, ask fora supervisor at the insurance company and speak to them as soon as possible about what happened, ask them to override it. Also, put your conversation with them in writing after you speak. They can override the first evaluation.

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  7. Great news about the 2nd opinion! I'm a "go with your gut" kinda gal too...there's definitely something to be said for "Mother's Instincts"! As for the appeal call I'd submit a letter explaining the circumstances and explaining that the outcome of the 2nd evaluation results in a cost savings to the health plan. In my experience, it's all about the bottom line with them, they want to know how what you are asking for will save them money. Good luck!

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  8. I'm sorry I've been so MIA. You have such a great gut!!!!! Now can you bring me some candy? Let's celebrate!!

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  9. Reward away, my six-pack-abs girlie! That is why you gut os so spot on . . . no one dares mess with the furry of your belly!

    Go ahead and mess with the insurance. They need some excitement in their day. Then come back and write all about it, cause I know the story will be g-o-o-d ;)

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  10. also agree with sending the letter from the second therapists and also maybe a nice little note from an attorney if you are lucky enough to find one with a juris doctorate by his name as well . I hate insurance companies and their little hidden policys .

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  11. I knew you knew. Mother knows best! So celebration-worthy!

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  12. thankgoodness for that!
    enjoy the chocolate :)

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