A reader writes:
When my son was learning to talk, he had a speech impediment severe enough that no one except my husband and I could regularly understand him. He was being bullied by other kids, and our doc worried that he would be unable to do well in school because of his difficulty. Our primary care doc referred him to speech therapy, and we called our insurer, United Healthcare, ahead of time to get pre-approval and jump through all the necessary hoops. It was approved, and he started weekly speech therapy. After six months of covered therapy, United Healthcare decided to start denying claims, but waited three months to inform us of this fact, letting us rack up an additional $3000 in speech therapy bills that they now refuse to cover. The only explanation I've gotten from UHC is that "this diagnosis is not covered under your policy," but his diagnosis has never changed, and they did pre-approve the therapy and pay for his first six months of treatment.
I have never been given an explanation of what changed to cause the later claims to be denied. I've been fighting the decision, but of course the speech therapy provider will not see my son while we've got an insurance dispute pending, so he's been kicked out of therapy. My son is starting kindergarten this week, and although his speech is fortunately much improved, he still has problems to work on, and will not be eligible to start school-provided speech therapy until next year, when he starts the first grade. Meanwhile, we're still fighting the insurance company, and calling or writing the speech therapist every week, asking that they not report us to a collection agency while we get this worked out.
I know many people have far more difficult situations than we do, but I just wanted to share one story of how an insurer can determine when and whether you get care, even when you supposedly have "good" private insurance.