Katy in horse therapy

Investigational and Not Medically Necessary

May 18, 2010

Investigational and Not Medically Necessary. Experimental. Or maybe you’ve seen the code “incidental.” Know what that means? It means the insurance company is just “Not Paying.”

I remember not so long ago when I couldn’t even imagine using coverage above and beyond what my insurance would normally cover. Those days are long gone. Now are the days where we try to figure out ways to get Katy the therapy she responds to best while fighting with our insurance company to get more and more varieties of therapy covered.

Aquatherapy, the single-most effective form of therapy Katy participates in each week? Experimental. Horse therapy? Investigational and not medically necessary. Speech therapy? We get 20 visits each year. Guess how many total speech therapy sessions Katy had last year. Over 50. Thank God most of those we’re able to get through her school district. Chiropractor? The co-pay is more expensive than the treatment.

It boggles my mind that insurance companies are unwilling to pay for a therapy now – even when that therapy has been prescribed by her pediatrician – when it may drastically reduce the expenses needed to care for her later on in her life. Yes, I know, I used the word “may” in there. It just seems to me common sense to dedicate more efforts to preventive care rather than reactive care.

Now, I don’t want to make it sound like I hate my insurance company. On the whole, our current insurance company has done more for us than any other I’ve seen. I’ve even got specific case representatives I call on for questions and approvals. I never call the number on the back of the card anymore. These case reps know Katy’s situation and call me all the time to check in on her. That’s nice to have happen with an insurance company.

I would recommend anyone with a special needs child talk to their insurance company about getting a personal case representative. It may take you a couple of hours on the phone to get it worked out; but it will end up saving you literally hours on the phone down the road with strangers completely unfamiliar with your situation.

So, what do I think: Is horse therapy “investigational and not medically necessary?” I don’t know. Like so many things you run into with a special needs child, sometimes it’s almost impossible to figure out why your child has suddenly made improvements. Did Katy begin to balance on her own following her first year of hippotherapy because of the therapy or because her body was just naturally getting stronger? I’ll probably never know.

But we’re not stopping now. In the video below, note a couple of things: First, yes, that is Brobee from Yo Gabba Gabba that she is holding. She usually has her pal Muno with her; but not today. Why is she holding a doll and not the reins? We’ve never been able to get Katy to grab the reins. She just balances herself in the saddle. Secondly, when she does the motion up and down with her hands, that’s “walk-on” in sign language. Katy has no interest in the horse standing still. None.

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