I cannot begin to explain how much I hate health insurance.
For YEARS geneticists have wanted to test my 2 boys for various genetic disorders they believe may have played a role in their diagnoses of autism. Fragile X, to name 1. That little test costs $1200! However, our health insurance refuses to pay for it because they say the test itself is only good for information and cannot actually change anything or provide any benefit to the boys health.

I believe I may have reached through the phone and throttled that customer service rep. that day.

Had the same exact problem years ago. I think I reacted almost the same way your husband did. I was able to figure out the "right" diagnostic code by asking the therapist who had previously been successful in getting our claims paid. It is worse than an episode of the Twilight Zone dealing with these institutions.

Thank you, citymouse, for the heads up on the law! That is very good to know if our magic code doesn't work tomorrow. And I'm so glad you found me through SITS! I made so many great contacts this past week; now I'll NEVER get anything done, because I have so many great blogs to read :-)

Lynn: I'm going to tread lightly here, because I know you're right -- we could end up with the big fat Zippo. Dave and I both have a terrible inability to keep our mouths shut when faced with illogic. And the whole short-term/long-term condition weirdness is as stupid as the logic behind giving less coverage to those of us paying more or not giving us a code that our therapist gave them to get them to cover ... ARGHHGHGH!!! (BANDIT MAD!!!)

I just wish this country could pull its collective head out and decide that children and old people should get anything they need to get better. That's about as political as I get, but I'm pretty adamant about it. There shouldn't be any kids with autism unable to get therapy, and there shouldn't be any old people watering down their milk so that they can buy prescriptions. Dear lord, how did I make a detour on to this rant? I'll meet you in the bell tower.

Bandit must not be used for evil purposes...Bandit will rise up and revolt! I was going to say what Cheryl said...you have to be careful not to draw attention to the coverage that you ARE getting because you are getting it most likely under an apraxia or global delay diagnosis code. If they smell the old 299.0 you might not get anything. Luckily, the mental health and medical sides of these MHIC's don't usually talk to each other. Here's the ultimate irony: you are only supposed to get speech and OT covered if the condition is rehabilitatable (totally not a word) and not if it's chronic like autism. That's right: Short-term condition = all the coverage you want, long-term condition = goose egg. Makes sense, right? I need to fetch my sniper rifle again...

Stopping by from SITS and I love your blog.

In a former life I handled insurance billing. Your insurance company cannot refuse to tell you that information or even supply you with a copy of the claim if you request it. Next time that happens, tell them it is a federal offense to withhold your PHI (personal health information). The Office for Civil Rights is responsible for HIPAA and this falls under it.

Thanks very much for the suggestion, Mary! You are absolutely right; the people who know us and our son are MUCH more likely to want to help, and actually, the new ABA therapists have been bending over backwards trying to help us.

We tried actually going to his old speech and occupational therapy clinic -- we've recently changed locations. But we got put on hold/transferred so many times, that we went to the neurologist and bingo! We got the code. Or a code. We'll see if it's the magic Da Vinci code on Monday. If not, we're gonna go back to the speech/OT clinic.

The fight rages on ...

The part Mandy didn't mention is the wildly frustrating 20 minutes I spent speaking to Bandit BEFORE I actually got through to a real live person. Bandit wants to know my address, social, policy number, etc etc. Bandit does not understand a British accent, so I have to repeat everything again and again, before eventually resorting to my best Redneck impersonation, which of course works immediately. I am calling from work. All my co-workers now think I'm insane. And when I do finally get handed off to Bandit's living side-kick, I am asked all the same questions again. Unbelievable....

...but I think the therapist provides the code in order to charge the insurance company. And I'll bet you if you talked to your therapists, they may not have used the autism-specific codes BECAUSE they knew / found out that MHIC wouldn't cover it, so they used something similar and not autism-related. AND, I bet if you talked to them - they'd give you the code, for future reference and use.
I find that the people directly serving me, working with me, and having a hands-on role in my life are MUCH more receptive and helpful than the anonybots with headphones on the other end of the hold music.

*EDIT* Just looked at other comments, and saw you've already gone this route - good luck!!