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In a previous Blog I outlined our situation and the fact our Employer Provided Group Health Insurance had sent us an Initial Denial of Authorization for continued psychiatric residential treatment our 9-year-old daughter needs. We expected the letter, and knew our private group health policy had decided in a Doctor to Doctor meeting they would not authorize any further care. This time however, I decided to request a copy of all the documents the insurance company use to make their decision.
I called the “Appeals” number provided in the initial denial of authorization letter and exercised my rights to receive free of charge, copies of all the records and information the insurance company used to make their determination.
A few days later the envelope arrived and I scanned the papers. I hadn’t intended to file an appeal but, rather wanted the documents for our own records. I felt the insurance company had little knowledge about some of the past care Makala had received. Records had come up missing in the past so I wanted these documents for the future. When I read the file I was sent I had no choice but, to file for an appeal.
The information in the documentation the insurance company sent me was incomplete, inaccurate and completely unacceptable. The cover letter sent with the documentation was addressed to: Anna (The Biological Mother) I am not the biological mother, and would hope the insurance company isn’t so careless as to send the records of an adopted child to the biological mother, based on a telephone call.
At some points in the documentation my husband and I are referred to as, “Step parents”. We are not Makala’s Step parents we are her adoptive parents. Sometimes they have accurate information, but most of it was wrong! I may not care about an actual appeal but, feel I need to make some kind of noise just to correct some of the errors they have in their records.
I was very upset with the insurance companies documentation of the situation we have been dealing with trying to help Makala. The implications were serious and made reference that we didn’t provide any therapy, or mental health services between hospital visits. Notations about our parenting styles were made. Remarks that our daughter may not want to remain with “this particular family” were written. Diagnosis made by a doctor who has seen Makala for over 2-years were tossed out and ruled out–by some doctor who works for an insurance company?
We have the means to cover the costs of care for Makala. We don’t need to appeal the decision our insurance company made, in order to pay for the care Makala is receiving. I wanted these documents for The File I keep, and only asked for them so they wouldn’t get lost again. I will be writing an appeal letter, if for no other reason than to correct the documentation our insurance company has in their records.
I would advise that any time you receive a letter from your insurance company and it tells you that you have the right to records, ask for them–review them and make sure they are accurate.
I’m sure I will have a few more Blogs about this subject as things unfold.
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Blogs In This Series:
- Mental Health and Insurance: Advocating for Makala.
- Doctor-To-Doctor Review: Employer Provided Group Health Insurance
- Initial Denial of Authorization: The Letter.
- Copy of All Documents, Relevant to Your Appeal
Related Blogs:
- Understanding Employer Provided Group Health Insurance
- Primary and Secondary Health Insurance Coverage.
- Mental Health and Insurance: Statistics and Other Information
- Viewpoint: Health Insurance Dictates Treatment Options.
Glossary of Insurance Terms:
A | B | C | D | E | F | G | H | I | J-K | L | M | N | O | P | Q-R | S | T | U-V | W-Z
Families.com Blogs are for informational purposes only. Families.com assumes no responsibility for consumer choices. Consumers are reminded that it is their responsibility to research their choices properly and speak to a certified insurance professional prior to making any decision as important as an insurance purchase.