We also have multiple appointments (ST, OT, etc. ) for our child, and there is a 60 visit cap--unless medically necessary--so we've been able to get coverage approved beyond the 60 visit cap. I've also found it helpful to see if your insurance can assign you an advocate (for example, BCBS has one for autism) who can help you navigate approvals for medically necessary treatment beyond the caps. This has helped us tremendously. You may want to ask your HR department to see if they can contact your insurer to help put you in touch with an advocate (internal to the insurance coverage). If your child has a disability such as autism, which often has state mandates for approval of certain therapies, that is often very helpful to note in your conversations with insurers. And, it sounds like you are doing this already, but document every call, every interaction you have with insurance. I have sadly filled several notebooks with this, but it is very helpful in the long run.

Anonymous wrote: I am fed as is exdh and I don't think anyone (like your dc) can be enrolled on two federal plans at one time.

I'm quoting myself as this point seems to have been missed. OP said they are both feds, the child cannot be on two fehb plans at once.

Anonymous wrote:

Anonymous wrote:OP, we have a medically complex child who has 6 therapy appointments a week. We have Kaiser who continues to approve therapy referrals despite the fact that we blew threw the therapy limits months ago. And they’ve knowingly done this for years. If they think it’s medically necessary, they will cover it.

Out of Network?

Therapy isn’t provided by Kaiser, if that’s what you mean by out of network. They have a list of therapists they have contracts with that you can chose from. We go to a larger center that offers OT/ST/PT with multiple therapists in each area. We picked them primarily because the location worked for us. We now realize that a larger center is more efficient to be able to double up on therapy appointments so we’re taking three separate trips each week instead of six. It’s also less administrative work to only deal with one provider, and it was easy to switch between therapists to find the right fit for our kid. Our daughter is very strong willed - has been that way since the beginning - and she runs roughshod over passive people, including adult therapists. We had to move between therapists at the center until we found good matches for her. As she’s aged, we’ve continually needed to reshuffle therapists. One therapist who was a terrible fit for her at 1.5 is now a wonderful match for her at 3.5. We wouldn’t have switched so much if we were working with solo therapists, but I see clearly that when her therapist is a good match, she makes more progress.

Anonymous wrote:When we were dealing with therapy for our toddler and insurance was refusing to cover it, our therapist told us to contact the DC Ombudsman for Health Care.

I’ve been through the process. I found it to be a waste of time - and a huge time suck. At the hearing the doctor who would be decided don’t did not even listen to our presentation.

Anonymous wrote:You should both max out the FSA

I don’t think you are allowed to do this, unfortunately.

Anonymous wrote:

Anonymous wrote:You should both max out the FSA

No, you cannot do this - amount is per famy, not per individual

FSAs are limited to $2,850 per year per employer. If you’re married, your spouse can put up to $2,850 in an FSA with their employer too.

https://www.healthcare.gov/have-job-based-coverage/flexible-spending-accounts/

Coordination of benefits… it’s a thing

Anonymous wrote:You should both max out the FSA

No, you cannot do this - amount is per famy, not per individual

When we were dealing with therapy for our toddler and insurance was refusing to cover it, our therapist told us to contact the DC Ombudsman for Health Care.

Anonymous wrote:

Anonymous wrote:OP, we have a medically complex child who has 6 therapy appointments a week. We have Kaiser who continues to approve therapy referrals despite the fact that we blew threw the therapy limits months ago. And they’ve knowingly done this for years. If they think it’s medically necessary, they will cover it.

Out of Network?

Kaiser is the way to go *IF* you are certain that they have the in-network therapy you need or you know other families with kids of a similar profile who are getting out of network therapy/care approved.

Anonymous wrote:OP, we have a medically complex child who has 6 therapy appointments a week. We have Kaiser who continues to approve therapy referrals despite the fact that we blew threw the therapy limits months ago. And they’ve knowingly done this for years. If they think it’s medically necessary, they will cover it.

Out of Network?

OP, we have a medically complex child who has 6 therapy appointments a week. We have Kaiser who continues to approve therapy referrals despite the fact that we blew threw the therapy limits months ago. And they’ve knowingly done this for years. If they think it’s medically necessary, they will cover it.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don't think you can carry two federal plans on the same people simultaneously. When I was divorcing and we were removing my ex from my insurance to his own (also federal) plan the paperwork got messed up and they cancelled my insurance midway through the year due to dual enrollment. It was a total hassle to figure out

Thanks so much for this. I’ll dig into it.

I think this is accurate.

Does anyone know which federal insurance plan offers the best coverage for tons of out of network PT, OT, etc?

Thanks!

I’m trying to figure this out, too. We have BCBS standard, but wondering if GEHA is better? Looking to max reimbursement for out of network coverage.

Your plan is only one piece of maximizing coverage. So much depends on the therapist’s charges.