Please read the entire post for some good news!
After my numerous Facebook posts on Cigna’s page, plus communication with the main HR person at my husband’s employer, Cigna has responded. I’ll attempt to keep this brief. Despite the external reviewer’s finding that speech is medically necessary for Eli, the terms of the plan only cover restorative speech. In other words, if you were in a car accident and lost the ability to speak, your therapy would be covered. However, if you are like Eli, and never had the ability to speak, your therapy is not covered.
BUT because Cigna was completely inconsistent in their reasons for denying our claims (not medically necessary/not rehabilitative/not covered under plan/etc.), and probably because I was (am) a big mouth, they worked out a deal with my husband’s employer. They agreed to cover 50 sessions of speech for each year we’ve been in speech so far–2016 and 2017. “Cover” does not mean fully covered/free for us, because of the type of plan, but we will be responsible for around 20% of the bill for those 50 sessions instead of paying in full. The 50 sessions covered all but a few of 2016’s sessions since he only went twice a week for most of the year (hello, 80% reimbursement!). We have already gone through our 50 for 2017 in the first four months of the year, so we will be reimbursed for around 80% of what we have spent to date. For the remainder of 2017, we will pay in full for each speech therapy session. However, because we’ve met the family deductible, our other in-network costs for ANY in-network healthcare (all of our providers are) for any member of our family will cost us 20%. Next year, 2018, Cigna made clear that we are 100% responsible for all costs with Eli’s therapy. But I’ll give it a good fight.
While we heard all this from Cigna last week, I waited to post until it was on paper and truly real. Today, I received a stack of EOB’s of all of Eli’s speech claims from 2016-2017. They were reprocessed and expedited last week. While I have not gone through them in full, I consider this a big win for #teameli.
This news comes just in time for apraxia awareness day on May 14, and this year, our special day coincides with Mother’s Day. I am so proud of Eli for how hard he works and how far he’s come. I am proud to be a mommy of such a special, sweet, funny, loving and smart boy. His newest skill that he must have learned at school is spontaneously singing Bingo–while the lyrics are mostly word approximations and very abbreviated, he does the clapping and the letters perfectly. I’ll try to get a video soon.
Thanks for reading. #teameli #takethatapraxia