SO, when last heard from, the evil villain (aka INSURANCE COMPANY) had denied our claims. They stated it was because we did not get prior authorization. Thus, the dashing prince (aka RANDY) called them. Oh how Evil Villains hate to hear from Dashing Princes. He spent 2.5 hours trying to get through the snares and traps laid by the E.V. In the end, he was told the Knights (aka therapy providers) would need to file an appeal. (With no guarantee they would approve it)
So, the lovely princess (that would be me) called the Knights and told them what the D.P. was told. The lady in the Knight's office ranted and raved for some time telling me all the appeals they had sent and were denied. Alas, she said, she'd try again. She did, that very afternoon. Upon further discussion, I decided I needed to contact the E.V. and discuss another matter.
I call and after many buttons pushed to get thru the first layer of snares established by the E.V., I get to Nice Person. They always put N.P. on the first line of defense. It's easy. She's nice because all she has to do is disseminate
facts. If it's not in black and white, N.P.s get to turn you over to the next layer of defense. So, I ask N.P. how many O.T. visits am I allowed in one calendar year. She states, just the facts, 30. Ahh. So, I ask, how many have I used. N.P. states none. Ahh...now I'm thinking, whew at least I avoided a battle that I thought I was going to have to fight. Then N.P. says "You do have 4 P.T. visits" Dang. I guess I have a battle after all. So, I tell N.P. that "we have not had a P.T. in our home in over 2 years can you explain to me, how we would have 4 P.T. visits charged to us?" N.P. states: "Let me put you over to our Rapid (or was it rabid) Response team" Queue the hold music.
At that point, L.P. (that's me) contemplates hanging up. Then, L.P. decides NO I WILL NOT (unless of course the kids start screaming). Finally, R.R. lady gets on the phone. "Hi, I'm Lori with the Rapid Response team and I see you want to know about your P.T. visits on a,b,c and d dates". "Yes, especially since we do not use a Physical Therapist". I hear her clicking and talking out loud. I hear, "AH HA" followed by "nope, that's not it" several times. Finally, she says, "I'm going to put this back through to claims. You should have an explanation within the next 10 business days". We say our pleasantries and hang up. I'm sitting there thinking, E.V. is just using a delaying tactic. After all, time is on the villain's side.
Less than 24 hours later, D.P. gets an email stating E.V. is paying for our visits (since our deductible or most of it, is met). What the.....
Moral of the story: If ever you get sent to the Rapid Response team, Ask for Lori. (of course, she may have since been moved or fired as she did not do her E.V. assigned job) AND Send in an appeal!