Insurance company backs down after families complain about loss of speech therapy coverage

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CHARLOTTE, NC (WBTV) – Families in North Carolina who have disabled children were shocked to learn late last week that speech therapy sessions would no longer be covered by Carolina’s Blue Cross Blue Shield North. The insurance provider calls it a mistake, but customers and providers always 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 chromosomal abnormality, suffers from epilepsy and cognitive impairment.

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

“I think the goal of each of our children is to have normal lives and a big part of that is communication.”

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

That’s why Porter was shocked when news from North Carolina’s Blue Cross Blue Shield broke late last week that it would no longer cover speech therapy for children diagnosed with developmental delay. The ad was first seen on the insurance company‘s website by concerned parents and providers.

“I am absolutely worried. I called this morning to try to find out if my daughter was going to be covered, ”Porter said.

Not only did Blue Cross’s announcement say Blue Shield would not be covered, but they also sent letters to vendors like Speech Matters’ Ashlyn Lelej seeking to recoup two years of claims.

Lelej has received over 50 letters requesting various amounts of payment.

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

“No, that’s the thing, not that far off the plan,” Lelej said.

Lelej said reimbursing these claims would be a nightmare.

“I don’t even have a choice not to pay it because they will withdraw it from my current direct deposits from my current customer,” Lelej said.

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

Late Friday, Blue Cross Blue Shield released a statement claiming the removal of coverage was a mistake in writing, “Rest assured families and providers are not responsible for the cost of speech-language pathology claims for a diagnosis of developmental delay that we have reprocessed incorrectly. Going forward, speech-language pathology claims will continue to be covered for members diagnosed with developmental delay. “

They said it was “an improper benefit change in our system that resulted in claims being reprocessed in error.”

A BCBS spokesperson did not provide further details on how the error occurred.

Originally, WBTV received an email stating that other diagnoses would not be covered either, but in response to questions from WBTV, a spokesperson said that with attention deficit disorder, the problems behavior, conceptual disability, mental retardation, psychosocial speech delay and developmental delay would continue to be covered.

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

“I would like to see in writing that all plans that currently 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 take it back and think we won’t notice it and we don’t want it to become a trend where they start pulling other services,” Porter said.

BCBS NC said it will provide a written response to customers and suppliers indicating that these diagnoses will continue to be covered and that no refunds will be required.

Copyright 2021 WBTV. All rights reserved.


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