HMO HELL

I am returning to speech therapy on Thursday, after almost five weeks without it. Not by choice, by HMO. My insurance stopped coverage mid-treatment after seven weeks of care. I have spent the last month fighting to get it back. It took two months to get coverage for speech therapy in the first place, now a month to possibly return with coverage. It has been a stressful roller coaster of doctor visits and daily calls to anyone and everyone who could possibly get me back into the therapy I need.

I developed a medically diagnosed speech impediment. I speak for a living. It seems like speech therapy coverage would be reasonable.

The specifics of the situation are so tedious and ridiculous that it’s not worth describing in totality. Basically, an adult who develops a speech impediment possibly due to medication or mold exposure(see original blog post for details) is so unusual it’s difficult to provide a diagnosis with the right code that receives speech therapy coverage, and even good insurance plans, like mine, often have limited speech therapy care. In addition, there have been unbelievable mishaps, like my primary care doctor being dropped from my medical group mid-care, an office manager messing up the filing, a neurologist who did not run enough tests, the list goes on and on. It has been a tragedy of errors.

Yet, I keep fighting, because speech therapy was working. In almost two months of twice a week sessions, I learned strategies and practices that greatly improved my speech fluency. Those who have been along for this ride with me can easily tell my speech has improved greatly. If you have not talked to me in the last four months, there is still a noticeable difference from how I used to sound before all this happened. But, I have hope that if I continue in therapy, one day soon my speech will be back to normal.

In this HMO battle, as frustrating as it has been, I often think about all the people who have life-threatening illnesses and have to deal with this same insurance run around. The daily approved/rejected, Matterhorn of a ride has been emotionally draining, so I can imagine how horrible it would be if my life hung in the balance. In the end, I am thankful I have insurance -- from all accounts a really good plan. I am also thankful that I have close friends and family who have been willing to listen to me rant just to deal with the constant insurance mind games. I am thankful for a speech therapist who is fighting for me and the insurance coverage. I am also thankful for a new primary care doctor that is really coordinating my care. Mostly, I am thankful that I have an eternal perspective and know that God is working in the midst of this madness.

I am going back to speech therapy, because it’s working. I finally have a new insurance authorization code from my medical group, but there’s a real chance that 2-3 months from now the insurance company may reject the claim, I will be charged thousands of dollars, I will have to appeal, and the game will continue.

I developed a medically diagnosed speech impediment. I speak for a living. It seems like speech therapy coverage would be reasonable.