Health Insurance Blues

What’s more painful than severe chronic pain? Health insurance companies. It’s hard for me to say whether my current insurance company is especially cruel, or if it’s that my treatment needs have escalated to a point that I am getting uncommon treatments, which require more hoop jumping. It’s like a bad combo of their special brand of hell along with my doctors office.

I wrote the above in 2019 when I was losing my mind with some approvals for botox treatments in my fascial muscles and for neuropsych testing. I can enthusiastically say both are now resolved and went in my favor. But it wasn’t without a lot of calls, hours upon hours with the insurance company and my doctor’s office, some alcohol and some tears.

I don’t have a lot of advice to share besides to be diligent and don’t give up. I had a neuropsychologist evaluation that my insurance didn’t want to cover and after appeals and hours of calls to them and my doctor’s office, my insurance company covered the cost.

Also, make sure you know what your policy requires prior-authorizations for as it relates to your condition. My insurance company will cover botox in my fascial muscles and SEM, but if I don’t have a prior auth, it takes a bunch of appeals and proof I failed previous approaches for the insurance company to pay for each treatment, which is every 8 weeks. If your doctor’s office will do the prior auth process, it “approves” the treatments for the next 12 months. This means every time your insurance company is billed for the treatment, they pay it right away.

I also learned that for TMJ related issues, my insurance company won’t pay for physical therapy. It’s literally the only medical condition that they won’t pay for PT for. They will pay for jaw surgery, but not PT. Ummmm, ok. Mostly you just want to know I you’re going to have to pay out of pocket for certain treatments BEFORE getting them done.

In the case of the neuropsychology testing I had to do, it ultimately cost $4000. I would have had to pay it all myself if my insurance company hadn’t finally seen the error of their ways. Neuropsych stuff is especially difficult because sometimes it’s considered medical and sometimes it’s considered psychology. At the time, my husband’s benefits had separate insurers for medical and psychology. I had called prior to find out whether my testing would be considered health or psych, and they said it would be medical related. My issues are due to chronic pain. Of course, once it was billed to the insurance company, they said it was psych related. And the doctor’s office I went to wasn’t a preferred vendor for psych. FTLOG. Even with my due diligence I was going to be on the hook for $4000.

As you get into weirder diagnostics and treatments, it’s worth reading up on what your insurance covers and what their exclusions are. Otherwise, the medical bills alone will break you. Good luck! If you need a good drink recommendation to get you through, I highly recommend Titos Vodka, sparkling water/club soda, and a splash of St. Germain. Cheers!

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