After over a year of fighting the AAC battle with insurance we have WON! I can't say THANK YOU enough to our SLP, and the others who helped along the way!!
Can I hear a Woot Woot?
If you haven't followed or if perhaps I didn't post about it (very likely lately) - we have been trying to get Daniel the EyePoint for his ECO AAC device. The upgrade came out within a couple months of us getting his original ECO. Immediately we started the process after seeing Daniel try it out when a rep came to speech one day (see video here).
Well of course the process is usually a few months, but then you have the cases lately with the economy and state cuts they try to make things even harder for you. So we got "requests" for more documentation showing the Daniel was able to understand what was being asked of him, when his language skills were. You can read more about that here. We went through this "request for more documentation" multiple times, which of course gives the insurance company another 45+ days to "review" the new information, or "review" the data that was already in the report sent to them in the first place. Just a big ol' pile of poop that they serve you to get you to hopefully give up and go away. Well, they obviously didn't realize that we don't go away. So we keep giving them what they asked for and more. We had letters from doctors, test results, videos, just about anything you could think of. Then in October of last year we got the final "DENIED" letter.
DENIED?? Are you kidding me? So I wrote in for an appeal (first time I'd ever done one), which had to be done within 30 days of the denial date. My question is here is why do they get to take forever to do it but I only have 30 days? Anyways, I sent in the paperwork and waited to hear some thing back. In December I still hadn't heard anything so I called them. Odd, they couldn't find any paperwork saying that we appealed.
After a few not so kind words on my part, I immediately faxed to them the original request. After a long time of getting the run around and repeated calls from me (almost weekly) to check the progress of our appeal, we were pulled to the top of the pile and a date was set. That office had to be sick of me calling that is all I can think of, or that when I called I would say "Happy Monday!" and end with "Ok I'll talk to you later this week to see how things are going!"
So we had our date this past Monday. Had to meet at our SLP's office which is normally 25 minutes away but of course we had a blizzard. YEP a mini blizzard in mid April. Not a good sign. Took us a little over an hour to get there. The "mediator" read one letter that our neurologist had sent to them the Friday prior (which can I add was also in the original paperwork that was sent in over a year ago, just re-dated but had the same information in it), and the frickin' insurance lady says "We retract our denial, and approval the upgrade to his device"
MONTHS AND MONTHS OF FIGHTING, FILLING OUT PAPERWORK, TESTING, STRESSING, SPEECH THERAPIST BUSTING HER ASS AND JUMPING THROUGH HOOPS TO GET WHAT SHE KNOWS DANIEL NEEDS, and you all of a sudden decide to retract?!?!?!
To say that we all sat there with a dumbfounded look on our face would be an understatement. But oh well - the end result, we got what we wanted. What I learned; they will keep requesting and denying and hoping that you will go away, just forget about it. What I hope they learned - Don't mess with Pat (SLP) or Daniel's parents because we DON'T give up!
Now, if you'll excuse us - we are still doing our happy dancin'