ON HEALTH INSURANCE

I received a call from a client who had been diagnosed withParkinson's disease about a year ago. She told me she was havingproblems driving and had heard that a medical center near her homewould perform an assessment to determine whether she had to give updriving or if there would be some sort of equipment that would enableher to continue driving.

I contacted her insurance company and found that, in thisparticular case, the initial assessment would be covered because thetesting revealed the patient could be helped by additional therapysessions. Her next step would be three sessions with a physicaltherapist performed in her car to determine what special equipmentwould be needed to assist her in her driving. These sessions wouldcost $130 each.

I again contacted the insurance company and was told that becauseshe could be helped, the subsequent visits would be covered under herplan and should be submitted with an evaluation and treatment plan.Regarding equipment needed in the car, this could be processed underthe durable equipment benefit of her policy. If any item would runover $500, the equipment must be pre-certified through the insurancecompany.

My client was thrilled that these charges would be taken care ofby her insurance plan and that even though she has a debilitatingcondition, with the correct equipment installed in her car, she willnot have to give up the independence of driving.

The lesson in this for all of my readers is to be aware of thebenefits provided to you in your policy. Do not assume these types ofevaluations and treatments will not be covered. When you call yourinsurance company for information regarding these types ofsituations, take down all of the information given to you over thephone as well as the name of person you spoke with.

The treatment must be deemed by the company as medicallynecessary, which in this case it certainly was, and my client did nothave to limit her activity because she could not afford to have theproper evaluations performed.

Barbara Melman is president of Claim Relief, a Chicago companythat helps people with health insurance problems. Write her at theChicago Sun-Times, 401 N. Wabash, Chicago 60611.