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[quote=Anonymous]hi, all.

our DS has been in weekly OT for the past couple of months for help with his posture/upper body strength and fine motor skills. before he started therapy, I called the insurance company (Aetna PPO) to see whether he'd be covered. I asked whether he was covered for OT visits (which, in hindsight, maybe wasn't a detailed enough question). the rep told me he'd be covered for 30 visits per calendar year. we were going out of network, so I was told the insurance would pay for 70 percent of reasonable/customary after the deductible.

we proceeded with therapy. the diagnosis code (781.3) we were given by the therapist was for hypotonia/low muscle tone.

thinking we'd be covered, we waited several visits before making a claim, so we could send several claims at once. big mistake.

we got notice that DS is not covered. I just called Aetna and the rep told me DS is not covered for OT for developmental delay. he said the diagnosis code the OT used was for "lack of coordination," which is not covered. so is 781.3 hypotonia or lack of coordination? I'm totally confused and worried that we will have to pay for all the OT ourselves. it's quite a bit of money!

I put a call into the therapist to see what advice she might give and whether she's willing to call Aetna to try to straighten things out (if they CAN be straightened out).

looking for any insight. thanks so much.[/quote]

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