Health Insurance Woes

I want to understand what my clients need to do in order to access health insurance for academic language therapy for dyslexia, so I’m testing it on my own insurance plan. It has not gone well.

Let me preface this by saying that I believe my particular insurer – UnitedHealthcare – is not a great example of what all health insurers are doing. I am working with families where the process has been smooth and the insurer open and communicative. BCBS has been particularly responsive and truly helpful and I am grateful to them.

I set out over a month ago to find out whether my plan covers a diagnosis of specific reading disorder, diagnosis code F81.0. I started with a phone call, which gave me an AI bot, which led me to a human in a call center. They were unable to answer, so they sent me to someone on their behavioral health team, who said it wasn’t covered under behavioral health, but when given the diagnosis code was able to say that is a covered diagnosis. However, they were unable to identify any therapies that were actually covered for the diagnosis. When I asked to speak with a supervisor who might be able to help my call was sent back to the AI bot.

UnitedHealthCare has a client portal and I was able to download a Benefit Summary. It’s a helpful, if general, document. It could not answer my questions. At the bottom of page one of that document is this paragraph:

“This Benefit Summary is to highlight your Benefits. Don’t use this document to understand your exact coverage. If this Benefit Summary conflicts with the Certificate of Coverage (COC), Schedule of Benefits, Riders, and/or Amendments, those documents govern. Review your COC for an exact description of the services and supplies that are and are not covered, those which are excluded or limited, and other terms and conditions of coverage.”

Okay. So the document I need is the Certificate of Coverage. It should be simple to get, right? Since it is the document UnitedHeathcare says I should review? Um, no.

This time I tried the client portal’s chat with a human (not AI bot) function. I asked specifically for the CoC. The person on the other side of the chat box took my email address and said they would email it right over. It never arrived. I tried again later in the week. Same experience, with the same assurances, and the same result. No document ever arrived. Yes, I checked spam and all the folders.

At this point I am hopping mad. This is clearly deliberate.

I back up, and go through employer Human Resources, as suggested by UnitedHealthcare in one of my calls. After a number of emails HR hands me off to someone at a separate company that administers their benefits, and I have two email back-and-forths with my request for the document and answers to my questions about coverage of dyslexia therapy. That was days ago, and no response.

Are you tired of reading this yet? Because I’m tired.

To summarize: it has taken me over a month to find out that someone at UnitedHeathcare believes F81.0 is a covered diagnosis, but cannot say what therapy might be approved. There is a document that I am told to review to get that detailed information, but I they will not give it to me.

My next step is to lodge a complaint with the State of Maryland Insurance Commissioner. Will that shake this elusive document loose? No idea, but on principle I want that document and I don’t like being stonewalled so I’ll keep at it.

The good news is that I don’t actually need health insurance coverage for dyslexia, unlike my clients. I can approach this as an advocate and not as a parent. If I were the parent of a dyslexic 3rd grader who needs services NOW that I could not pay for out of pocket, what would I do? Probably make myself even more a pain in the ass, with the urgency of my child’s needs behind me.