A real conversation I had with a really unhelpful customer service representative from the really horrible Idiot Insurance Company:
Mom: Your first letter states that Monkey was approved for 17 more PT visits, but the second one states that he is approved for only 8. May I ask why?
Idiot Insurance representative: The additional nine visits were the ones that he used when he was approved last month. In other words, he has 17 total.
Mom: No, he doesn’t. That makes no sense. If those were the visits that were approved and used last month, why are they included in this month’s statement?
IIR: Blah blah yadda yadda blah blah.
Mom: I’m also concerned that his diagnosis is listed as gait disturbance. As I stated previously, his diagnoses are stroke, CP, and SPD. Gait disturbance is just one of many symptoms of his diagnoses.
IIR: Mrs. Monkey, we are indeed aware that your son’s diagnoses include stroke, CP, and SPD. We are simply going by the physical therapist’s notes.
Mom: I’m looking right at the physical therapist’s notes. She has his diagnoses listed as stroke, CP, and SPD.
IIR: We still list it as gait disturbance because blah blah blah yadda yadda blah blah blah.
Mom: So are you telling me I will have to go through this process every 8 visits, and my medically fragile child will be left to deteriorate for weeks at a time until your company approves him for the services he needs?
IIR: Blah blah yadda yadda we always approve medically necessary services in a timely manner….
Mom: That’s debatable.
We have won a very small battle, but the war is still ahead of us.
Blah blah blah, yadda yadda yadda.