For those of you following our battle with Blue Cross and speech therapy coverage, we have a final answer.

We appealed through the State of NY and they later sent us a letter saying they were sending all of the info to an “impartial” 3rd party in Massuchusetts for review by medical professionals. I really thought this was going to work in our favor and this was all going to end well. I was shocked to receive the final denial from them along with some notes from the three professionals who reviewed the case. I was shocked especially to see the notes from a SLP stating services weren’t necessary. I just was blown away by this, especially when considering his neurological diagnosis and our supporting letters from the neurologist! I am convinced the insurance company must have these “professionals” in their back pocket because there is no good reason for a denial. My neurologist was even very shocked, saying she had never seen anything like this before and that it didn’t make sense.

Blue Cross is SO SO SO lucky that we are fortunate to have a fantastic SLP at school and that they added more sessions to compensate for this denial. Otherwise I would come after them so hard they wouldn’t know what hit them. This is all despite in their letter saying, “this is final, please don’t contact us on this matter again”. We are dealing with so much right now outside of his speech that I had to let this go. Like I said, they were lucky. I can make a huge pain in the butt of myself if the cause is right. But Blue Cross is permanently on my s*%t list.

I think I use more of my cell minutes on the phone with Blue Cross than I do with my friends, and I’m over it. I’m angry. It’s ridiculous.

I have had issues with them in the past regarding Henry’s coverage for therapy. I have made appeals and thankfully won. I was gearing up as we approached the cap of our 45 visits per year that were allotted, and assumed that was the next battle on my hands. I was preparing.

I was not expecting full denial of coverage for him based on the fact that he is now attending preschool. I have heard of this happening, foolishly I didn’t think it would happen to us. I had already fully explained the necessity of one on one intense and consistent private therapy for Henry…and I seemed to convince them. Now their view is that the school should be responsible for all of his therapy moving forward. We have a lovely and well respected speech therapist at his school, but he has a great connection with our private SLP and has made such progress with her and I don’t want to lose momentum. Why would we change something that is working? Why is it so hard to get our kids what they need? It makes me nuts.

I contacted BCBS again to go through the details of the appeal process and then I contacted CASANA for some guidance in drafting a letter. They were kind enough to share a sample appeal for a similar situation and I modified it for our case specifically. I got amazing letters from our SLP and neurologist  to support the appeal and I included the cutest picture of Henry I could find. Now we are waiting fingers crossed.

ps. I have another letter to BCBS stating how I really feel, holding nothing back. It was never sent of course, it’s something that is drafted only in my head and replayed every time I have to deal with their idiocy. I thought I would share it here, but then thought the foul language might offend :)