BCBS IL – Treatment does not match diagnosis code. Any chance of getting it covered?
At the end of last year I was diagnosed by my ENT with muscle tension dysphonia. I was referred to a speech pathologist by the ENT for speech therapy. I went to speech therapy. My dysphonia drastically improved because of it. But I was left with a nasty surprise that my insurance refused to cover the speech therapy.
When I looked at the denial letter, it stated "the treatment of speech therapy does not match the diagnosis code (xx.x)." My provider tried to use alternative codes, but none of those worked either. I filed an internal appeal with my insurance company. For the appeal, I provided patient records from my ENT and my speech pathologist and a letter stating that my treatment was necessary for my diagnosis from my speech pathologist. It was denied for the same reason that the treatment doesn't match the diagnosis. BCBS simply didn't recognize that speech therapy was a valid treatment for muscle tension dysphonia and appeal was basically in vain.
I am 100% confident that my speech therapy was necessary and the only valid option to treat my muscle tension dysphonia. The dysphonia also partially affected my ability to perform my job for a short period of time. But my insurance clearly isn't going to cover it.
I attempted to file a complaint with my state insurance commission. I sent the same documentation that I sent my insurance for the appeal. But all I received back was a letter saying that "my complaint was not a valid complaint and dismissed." Clearly, I filed something incorrectly. I should have done more research before filing the complaint.
Do I have any more options? I'm confident that I could get a personal letter from my ENT stating that the speech therapy he referred me to was necessary and the only viable treatment. I'm open to filing another complaint with my state insurance commission too.
The whole thing seems like an unfortunate technicality with my insurance. My speech therapy was so obviously necessary and important to treating my dysphonia. And I have support from my ENT and speech pathologist. But BCBS clearly doesn't recognize it.
submitted by /u/l33t_drummer
[comments]
