TPA excluded Botox for my child's Cerebral Palsy treatment under corporate policy. Is this deduction correct?
I have a corporate health insurance policy provided by my employer that covers all pre-existing diseases from day one. My 4yo has spastic Cerebral Palsy and recently had a 1-day hospitalization for Botox injections directly into his leg muscles, followed by a corrective cast to treat severe toe-walking. The procedure was performed by a pediatric orthopedic surgeon.
The TPA authorized the hospital admission but completely excluded the cost of the Botox vial and the injection charges.
Does this deduction seem right or wrong? I suspect their system auto-flagged Botox as a "cosmetic" treatment or they used a generic "IM/IV Injection" administration exclusion to deny the cost of the medication itself.
Should I raise a dispute for this? Has anyone dealt with a similar situation?
P.S. Used AI for drafting the post.