Perhaps victory is a bit of a strong word to use for this scenario, but none the less. The same day we found out that Mark’s genetic results were back I received an Explanation of Benefits from Mark’s self insured plan that I obtained through the state. It indicated that Mark’s Kennedy Krieger program was not covered, and in fact, all of it was denied. The entire reason I hunted, fought for, and ultimately, by the grace of God, obtained his additional insurance was to pay for THIS program. And why is this such a big deal? Because Mark’s program costs $1,500 per WEEK. That’s $6,000 per month. Yeah…
When I received the phone call from Kennedy Krieger I was under the assumption that it was the billing office responding to my desperate email regarding his account, but instead it was the neurogenetics department offering us some other news…
After we wrapped our heads around the genetic mutation situation, I resumed my insurance coverage battle. I was armed with written communication to demonstrate that the speech program should be covered, that I was unaware of a prior authorization needed and my insurance information was submitted well in advance of his program’s start date. Then I received an email that simply stated that Kennedy Krieger is working with Care First to remedy the situation. There was a system wide issue with Care First’s prior authorization service and that regardless of the outcome, if they would be able to resubmit the claim or not, we would not be responsible for anything beyond our copay. I won one! Finally, I was thrown a bone, and oh how appreciative I am of that bone.
