The Po Show

I Think I'm Going to be Sick

The claim I submitted for Matthew's therapy visits in Nov. got denied. I called to find out why, and was told that we had exceeded the maximum visits allowed in a calendar year. I hadn't been told there was a maximum number, but yes, it was 30.

I totaled up the amounts for all of his visits in 2007, and how much we got reimbursed by the insurance company.

We paid: $5,850
They paid: $1,372.52

So now I got a new authorization number, and we can start submitting claims again for this calendar year. We have to pay a $1,000 deductible first before they start paying. However, as I found out last year, it's $1,000 of *their* share. So, for example, a visit to the psychiatrist is $250 (he goes every 3 weeks). The maximum amount allowed for a visit is $200. Of that, they pay $140. So for a $250, only $140 goes towards the deductible. A visit to the therapist is $175 (he goes once a week). The maximum amount allowed is $120. Of that, they pay $84, so only that much goes toward the deductible. So by the time we've hit the deductible amount, we've paid about twice that much, or over $2,000. Then they start paying, up to 30 visits.

He absolutely needs this, and it's helped tremendously, but my stomach is in absolute knots. I was really counting on getting the money back from the last claims, and the thought that we have to get back up to the deductible again before we see any reimbursement makes me want to throw up.

And we have GOOD health insurance!