Insurance Nightmares

Insurance is a nightmare.  Add a special needs child and that nightmare becomes something you are living on a daily basis.  J and I are currently working on figuring out just how our insurance is going to work for all of Frogs needs.  Let me tell you he has a lot of needs. 

Currently my insurances is a great policy.  $500 deductable, then 80/20 till the individual hits $1000, then 100% coverage.  GREAT!  except... More on that in a minute

J's insurance isnt as great.  His is a $4000 deductable, then 90/10 until we hit $2500 out of pocket, then 100%.  Ok, so the $4000 is a bit (lot) of an ouch, but it is doable... right?

  Now the catch.  I went to the website for both insurance companies and pulled up the list of prefered providers for Autism... Yep they had a drop down list that allowed you to select "Autism" as the type of provider you are looking for and it pulls up a list... With no-one on it.  During the process of becoming pre-certified for Frog's diagnosis, I asked the nice (ha!) people I spoke with about coverage rates and was told the provider would be covered at 80/20.  This all happened towards the begining of January.  Apparently I had spoken with the wrong person...
 
  Now- We are having problems with J's insurance.  Because J is Frog's step-dad and I have full custody of Frog, my insurance is supposed to be billed as primary and J's is supposed to be billed as secondary.  J's insurance had this backwards.  No biggie except they refused to look at anyone's claims until this was straightened out.  While trying to figure this out I see my insurance company paid half of Frogs claims at 80% and half at 50%, so I call to try to figure out what is going on.  They tell me there was a "mistake" and since his provider is out of network, we  have to pay the visits at 50/50.  Now nowhere in the billion other phone calls that I have placed to them (or the ones where they have called me) has anyone mentioned there was an issue with the provider being out of network.  Remember, I did ask about rates and was told 80/20. 
 
  Now we are waiting for my company to call back with an answer on if any of the 9 psychologysts that are in their network have the ability to test for "Autism".  If the answer is yes, they get to go back and bill me for the bills they "overpaid".  If the answer is no, we might be able to get them to go back and pay the bills that were only paid at 50%.  We are hoping and praying that the answer is no. 

  Oh, but what about J's insurance.  Well that $4000 deductable we are working on?  They only count what we pay out of pocket.  So while we have paid $5000 so far towards Frogs Autism testing, they have only counted $748 worth. 

  All of these numbers are just for psychological testing.  We are still waiting on a Medicade card from the state to get him into phycical Therapy, Occupational Therapy, and Sensory Therapy.  All these numbers make my head hurt.