Insurance company backtracks after families complain about losing speech therapy coverage

Juliana Porter and her daughter Lily talk with WBTV about the importance of speech therapy in...
Juliana Porter and her daughter Lily talk with WBTV about the importance of speech therapy in their life.(WBTV)
Published: Dec. 13, 2021 at 5:14 PM EST
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CHARLOTTE, N.C. (WBTV) - North Carolina families who have children with disabilities were shocked to learn late last week that speech therapy sessions would no longer be covered by Blue Cross Blue Shield of North Carolina. The insurance provider is calling it a mistake, but customers and providers still want more answers to make sure they’re covered.

Juliana Porter and her daughter Lily have no problem preaching the importance of speech therapy. Lily was born with a chromosome anomaly, has epilepsy and cognitive impairment.

“So she’s very far behind her peers and needs a lot of catching up and a lot of help through therapy,” Porter said.

“I think the goal for any of our kids is to have a normal life and a huge part of that is communication.”

“So it’s huge. It’s huge to have that,” Porter said.

That’s why Porter was shocked when late last week news broke Blue Cross Blue Shield of North Carolina announced it would no longer cover speech therapy for children with a developmental delay diagnosis. The announcement was first seen on the insurance company;s website by worried parents and providers.

“I’m absolutely concerned. I called this morning to try to find out if my daughter was going to get coverage,” Porter said.

Not only did the announcement from Blue Cross Blue Shield say it wouldn’t be covered, but they also sent letters to providers like Ashlyn Lelej at Speech Matters seeking to recoup two years of claims.

Lelej received more than 50 letters requesting various amounts of payment.

“Have you ever had a situation like this arise?” investigative reporter David Hodges asked.

“No, that’s the thing, not this far away from the plan,” Lelej said.

Lelej said paying those claims back would be a nightmare.

“I don’t even have a choice to default on paying it because they will take it out of my current direct deposits from my current client,” Lelej said.

“So I can’t even say wait a minute let me argue this.”

Late on Friday Blue Cross Blue Shield released a statement saying the withdrawal of coverage was a mistake writing “Please be assured that families and providers are not responsible for the cost of speech therapy claims for developmental delay diagnosis that we reprocessed incorrectly. Moving forward, speech therapy claims will continue to be covered for members with a developmental delay diagnosis.”

They claimed it was “an incorrect benefit change in our system that caused claims to reprocess in error.”

A spokesperson for BCBS would not provide any more details on how the mistake happened.

Originally, WBTV obtained an email indicating other diagnoses would also not covered but in response to questions from WBTV a spokesperson indicated attention deficit disorder, behavioral problems, conceptual handicap, mental retardation, psychosocial speech delay and developmental delay would all continue to be covered.

Lelej is still waiting for evidence that the insurance company will follow through.

“I would like to see in writing that all of the plans that currently do cover developmental delay will continue to cover developmental delay,” Lelej said.

“We’re educated, we’re watching and you know you can’t just say something and then retract it and think that we won’t notice and we don’t want this to become a trend where they start pulling other services,” Porter said.

BCBS NC said they will provide an in-writing response to customers and providers that these diagnoses will continue to be covered and no back payments will be required.

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