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Monday, June 22, 2009

Going Good!

We had two wonderful dives today - Brextin did have a mini-seizure lasting about 10 seconds during the first dive - but other than that he was a good day - he had been working real hard in therapy. I will add pictures today as well.

Brextin is working on getting his hand to the side to catch himself, standing without bouncing, and rolling over to his belly, even yoga - the speech therapist said he had the best session ever - his tongue is getting out further and he is clicking his tongue to the top of his mouth - he is taking turns making sounds - he has even chewed up tiny bits of cookie - way to go Brextin!

Everything is going well here in Madison - unlike at home -When I was home for the weekend I opened up a letter indicting that MA denied a bill that was sent to them from our therapy center which is located 60 miles away from our home - we seek out additional therapy for our son - because I strongly feel he is advancing because of the double therapy sessions (our neuro has written out a script seeking therapy 3 times a week) - he is seen by our birth to three team as well at a center which is located 60 miles away - however I just received a notice that we have been denied for OT sessions at the center 60 miles away and that we were denied because MA won't pay for two separate services - The letter states we were denied because the center was to perform a prior authorized letter - which was never done - and now that they have provided services they would like to be paid.

I have 45 days to write a letter to appeal their report - I have no idea what should be written - the center has always billed our insurance company and so I didn't think that they would bill MA as well - since Birth to three does not bill our insurance company and only MA. The letter was dated June 9th and since I am away from home and am located 3 hours away - I have no idea how I am going to be able to fight this - as if I don't already have my plate full -

Why is it that things are made so complicated - I just want to do the best that I can for my son but why is it that I have to be put through the ringer to do so!

I don't even attend the sessions at the center located 60 miles away since I work full-time (so I am unsure as to what is being performed - to really fight the appeal) - (it would be nice if they sent home a letter indicating what was being worked on (our birth to three does this) - sometimes I get an email indicating what was performed- or if he had a good/bad session but usually only one of the three therapist is consistent) I am so fortunate that my mom takes him back and forth while I am at work - I really value their work at the center and really like them as therapist - but am not interested in paying an additional $8,000 for OT and PT when it should have gotten a prior authorization! If I had any idea that their services would cost me in addition to our insurance then I would have dropped services and done the work myself! Why didn't it cost me extra before we had MA - hmmm -

We have been going to the additional center since Brextin was 1 years old - so we have been clients for over one year - I was looking forward to going back there when we are done here in Madison - but that won't be occurring if I have to pay additional money.

I am just very upset - my husband tells me - slow down - everything will be ok - ok - is he sure - he doesn't have to write the letter of appeal - he doesn't attend any of his therapy sessions - he doesn't know anything about his therapy - not even their names - IIIRRK ! I am really irked right now!

I need to take a break - I will post tomorrow when I am a little more relaxed -

ooh ya - plus we are up for his ISFP meeting when we get back and strongly feel as if vision therapy is needed and our local birth to three doesn't offer vision - so now I am stuggling to find who can perform the services that are needed to enhance my son's life!

It is one thing after another!

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