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Kids With Special Needs and Disabilities
Reply to "Therapy coverage appeal "
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[quote=Anonymous]Check your benefits manual and see if there is an out of network option that can be available if no provider in network is available within a reasonable time and distance to see your child. Basically, you have to show as prior PP did that their network is "illusory" and an out of network provider is needed. Also if you have the opinion of an M.D. that these services are medically necessary then whoever is reviewing the decision should have at least the same level of licensure/qualifications. You should have someone who is at a lower licensure level so to speak second guessing the medical judgment of an M.D.[/quote]
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