My son has been diagnosised with ODD. He is 11 years old and has been on Concerta for 2 years with awesome results.
He also sees a therapist(for the past 4 years).....but now my insurance company has changed its rules and they say that my son has to see someone else in the "network". (the past 4 years they have allowed my son to see someone "out of network" because he is the only one in my area who specializes in my sons ODD.) My question is ....shouldn't they "grandfather" him to stay with the therapist who he has a repore with and who has great results with. Wouldn't it defeat 4 years of therapy to start with someone new??? Why do insurance companies screw up a good thing? And are there any books or websites I can go to that will help me write an appeal to the insurance company? thanks in Advance
I don't think they have to grandfather in. When my insurance changed my school district opted to keep our mental health portion of our old insurance plan since changing to another plan would of affected a lot of people having to find a new doctor and or therapist. For this I have to give a huge thanks to my employers.
As for changing to someone else... I don't think it would change too much. My son's doctor stopped taking our insurance and I didn't want to pay him out of network costs. He was ridicuously high. So we changed and they accepted all of our info. from previous doctor. We actually feel the new doctor is much more thourough in actual visits. He and his nurse practioner truely know how to work with our son who is 6 years old. They talk to him and then me. The old doctor only talked to me. I always thought that was strange but just assumed it was the way things were done as I had nothing else to compare it to.
dear dmoreo, your plight is a compelling one. If you've spoken to an insurance rep. with authority about this and know to be true that this policy change forbids any ininsurance assistance in continuing to see the same psychiatrist, you are right in wanting to submit an appeal.
The state you live in may have some board or authority that considers issues such as yours. If you work for a firm or organization, you may want to share your concern with the appropriate person there also. Here is a link showing contact information for each state, which may not lead you directly to whoever might help you, but at least gives you a place to start! http://www.comp.state.nc.us/ncic/pages/all50.htm
My son as a repore with this therapist and he trusts him. The therapist talks with me AND my son. And we all understand each other. At the age of 11.......and the experiences my son has with teachers who "label" him, I believe to change therapist would erase all the progress we have made.