Denied therapy coverage

Are insurance companies bound by what representatives tell us? Are there certain “rules” that benefit coordinators follow?

I previously posted about my EMI insurance denying claims for my daughter’s therapy visits (She’s diagnosed with Angelman Syndrome, autism and other less severe dx). The plan has a hard limit of 20 visits. I’m left paying out of pocket for therapies I was told by representatives that I would be approved.

I have phone calls from them. I’ll post the summaries below. But basically I asked for a more detailed plan, and told this two page document was it. I was also told that with an Autism diagnosis the hard limit would cease. We’ve gone through two rounds of appeals. In the appeal statement the coordinator wrote a very biased and incorrect statement. I assumed that the appeal would be like a grand jury where facts are presented representing both sides of a case.

Yesterday I got a phone call stating that I owe more money to my speech therapy, I asked the coordinator if that was the case and got a very rude response with the phrase, “Once again.”

We live in Texas and are on a Medicaid waiver list. We don’t qualify for chip, Medicaid buy in, or children with special health care needs.

submitted by /u/emmaleeann1
[comments]