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United health and speech therapy- Lakewood

 
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amother




OP


Post  Fri, Jun 14 2019, 10:50 am
So I went for an evaluation with my child at a place that is accepting United health community plan.
Therapist agreed my child needs speech.
United sent out a letter stating they will not cover since it’s not medically necessary.
Has anyone dealt with this?
They did give an option for the doctor to call to explain why it’s medically necessary. What could the doctor say?? (Aside for the fact that this child is not understood and is old enough to be expected to speak intelligibly)

Has anyone had United cover speech therapy recently??
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amother




Lavender


Post  Fri, Jun 14 2019, 11:44 am
UHCP only covers for certain diagnoses. I don't know what the diagnoses are, sorry. But surely the agency has dealt with this before? I use Children's Specialized Hospital for OT and never had an issue. I know they provide speech as well.
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amother




Honeydew


Post  Fri, Jun 14 2019, 11:59 am
I had my pediatrician write my a script. Also have uhcp. Didnt have an issue
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amother




Pewter


Post  Fri, Jun 14 2019, 12:14 pm
Since last fall United healthcare community plan cut most local providers out of network. Until then they were very lenient on approving therapy but that may have come back to bite them. I don't know what their criteria for therapy are but speaking clearly is not considered medical need to my knowledge. When I had Aetna and speech was only covered for significant medical diagnosis (such as and neurological disorder, tumor, cleft palate) even Adhd or learning disabilities were not significant enough. I don't know where autism falls right now or if there is a mandate requiring them to approve therapy for that. The only local place I know of that is on network is children's specialized. Good luck!! I hope you can get the help your child needs without paying out of pocket.
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amother




Seafoam


Post  Fri, Jun 14 2019, 12:16 pm
It has to be billed as a medical issue.
You can try another therapist to see if they will bill correctly. Sometimes they will try multiple times with different codes. Different therapists are more flexible with this.
I think many therapists are getting more afraid of this.

unfortunately articulation isn’t considered medical. It would have to be mouth issue, hearing, etc.
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amother




Forestgreen


Post  Fri, Jun 14 2019, 12:17 pm
amother [ Lavender ] wrote:
UHCP only covers for certain diagnoses. I don't know what the diagnoses are, sorry. But surely the agency has dealt with this before? I use Children's Specialized Hospital for OT and never had an issue. I know they provide speech as well.


I’m using children’s now and they just called me with the same issue!
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amother




Forestgreen


Post  Fri, Jun 14 2019, 12:18 pm
amother [ Honeydew ] wrote:
I had my pediatrician write my a script. Also have uhcp. Didnt have an issue


When was this? I had script written and was still denied.
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amother




Lime


Post  Fri, Jun 14 2019, 12:33 pm
I also just got a call from CSH that speech is being denied. However, OT and PT are still being covered. Anyone had success in resolving this? A new referral didn't help us.
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amother




OP


Post  Fri, Jun 14 2019, 12:34 pm
Op- it was Children’s hospital...
Not sure if they will rewrite anything after that evaluation
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amother




Linen


Post  Fri, Jun 14 2019, 12:51 pm
You can try to get your pediatrician to do a peer to peer call. It is time sensitive. IIRC, you have only 48 hours after denial. Not sure exactly. You can ask your insurance company. We were doing speech at CHS under United Healthcare, and then services were denied. Our dr. called and we got another 9 visits after he championed the cause so to speak, and it made a real difference to our child.
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amother




OP


Post  Fri, Jun 14 2019, 1:39 pm
amother [ Linen ] wrote:
You can try to get your pediatrician to do a peer to peer call. It is time sensitive. IIRC, you have only 48 hours after denial. Not sure exactly. You can ask your insurance company. We were doing speech at CHS under United Healthcare, and then services were denied. Our dr. called and we got another 9 visits after he championed the cause so to speak, and it made a real difference to our child.


Yes, we were told about the peer to peer. I’m trying to figure out what to tell the doctor to say to the insurance.
What did your doctor say?
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amother




Forestgreen


Post  Fri, Jun 14 2019, 6:58 pm
amother [ OP ] wrote:
Yes, we were told about the peer to peer. I’m trying to figure out what to tell the doctor to say to the insurance.
What did your doctor say?


They told me something about peer to peer. What’s is that?

Another question- thinking about switching providers- anyone switched and got covered in either Aetna or amerigroup?
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amother




Lime


Post  Sat, Jun 15 2019, 11:07 pm
I was on Aetna and was covered. The question is how many times do they allow switching HMO?
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