Fighting HMO for PT Benefits Exhaustion Override
 

My 8 yr old daughter was diagnosed with RSD in December 2008. At that time it was only in her leg. She started PT and was improving. Then she got the flu and had a relapse. Now her entire body is affected. The problem is that she has maxed out her PT benefits for the 2009 calendar yr. Has anyone had any luck fighting an HMO for a benefits exhaustion override?

I've never had deal with the maxed out issue with an HMO. Just make sure you're in-fact maxed out get it in writing from them. I do not trust HMOs at all and had to fight them tooth and nail to force them to pay up for my wife's treatment for RSD. I dumped them and picked up BC/BS PPO with no lapse in coverage. The switch on insurance was through my employer (group insurance.)

check with your doctors' office
 

Perhaps your medical provider or the physical therapist will know how to go about getting an approval for you beyond the standard amount. Sometimes its just a matter of writing the request a certain way. Many of them are very knowledgeable regarding that stuff. My pediatrician helped me out often when my kids were little and we had an HMO plan.

It's worth a try - good luck! Sandy

Your daughter is 8 yrs.old, and she should fall under your State's Medical Program for Children.

Contact the Department of Human Svc. office in your area, and request a medical application for your child. All children under the age of 18 should be able to be covered. Depending upon your income, you may not have to pay anything, or at the most, a small fee to cover your child's medical expenses..

Before RSD/CRPS, I was a social worker for the State of Ok.

I hope this assists you and your child.
:hug:

dew is right
she should be able to get this period... becuase of being a kid. my kids are on it due to asthma being pre exsisitng . and medicade is all that will cover me for my rsd.. since i was 16 when it happend
and i wasnt able to get life time medical from my auto accident

i would surely look into this if i were you they pay for alot more harder sometime on meds but not treatment


carrie

Plan A

You need to go to her PCP. It will be some work on his part, but he needs to right some reports on your daughter's behalf. He knows how to write a few certain words to get it over rided.

Plan B

Occupational therapy