schools billing insurance

Tommy brought home a letter that would give the school permission to exchange information with the insurance company. I don’t think any good can come from the school accessing insurance records. I do think that the school billing insurance for any services that Tommy is given during school hours is very wrong. Tommy doesn’t receive physical therapy, speech or any other services that he could get independent of school. Everything that happens at school is clearly positively correlated to his getting an education. Technically, it’s all geared toward his passing the Gateway tests to graduate but that’s a different issue. The schools already receive extra money for special education students and although I know that they are underfunded and desperately searching for solutions, running up our insurance premiums and moving us closer toward capping out of insurance is not the answer. While I don’t believe that parents who homeschool deserve to have their child’s OT or PT provided by the school, I do believe that the school doesn’t provide Tommy anything he could get elsewhere.As much as I trust and genuinely like Tommy’s teachers, the school keeps Tommy very isolated and uninvolved in all of the educational and athletic activities that benefit mainstream students physically and emotionally. I have Tommy enrolled in school to have positive relationships with his peers. Tommy is capable of more than we will ever know and that makes me sad. Asking families of children being left out and left behind to pay for the education that other parents and students take for granted, that just makes me angry.

8 thoughts on “schools billing insurance

  1. Read through the request again. I could be wrong (my wife usually thinks I am), but I think it is possible that you may be mis-interpreting this request.

    And my first impression is that it is far more devious and sinister than you think. A request that would allow the school to share information with the insurance companies has nothing to do with billing (not directly). If they were going to bill them for a “service provided” in that case, there would be no need for a HIPAA waiver.

    By allowing the school to share information with the insurance company (and assuming the insurance company is doing this on some large scale), it will allow the insurance companies to build “statistics” for denying coverage, altering coverage, creating special waivers for kids that have special needs etc.

    What I suggest you do with the school is Ask the Question! Why? Who is this for and what is the benefit? And don’t be ready to accept a simple answer. More than likely the school will be getting some sort of payout (excuse me, “donation” or “stipend”) from the insurance company for access to the information, so expect that they will push you hard for the waiver. After all what school doesn’t need money for programs these days?

  2. Wow, yeah, if you want to share something with your insurance company, that’s fine. But what the school have to do with it? Very suspicious, to me. I’d be asking lots of questions.

  3. Here’s the text of the letter (typos included – I count 3):

    May 15, 2006
    Dear Parent or Guardian:

    The Bureau of TennCare and the State Department of Education have started a new program that allows Tennessee schools to be reimbursed for the Individual Education Plans (IEP) related services that are that are provided to Special Education students. Related services include Physical Therapy, Occupational therapy, Speech/Language Therapy, Hearing/Audiology Services, Nursing Service and Behavior Health Counseling.

    Knox County Schools will be billing TennCare for some of the related services that are your child is receiving during the school day. Your child’s TennCare privileges will not be affected and we will continue to provide all related services to your child as usual.

    Please sign the enclosed Consent for Disclosure of Information form; which will allow us to release the required information, which is listed on consent form, to TennCare and their authorized representatives.

    Please return the signed form to your child’s teacher by May 24, 2006.

    Thank you,
    Margaret Harris, RN
    Health Services Case Manager

  4. The consent form:


    I understand that the __Knox County___ Schools will disclose certain personally identifiable information from my child’s educational records to Medicaid and its authorized representatives for the sole purpose of requesting reimbursement from Medicaid for certain medical services that the schools provide to my child pursuant to his or her individualized education plan under the Individuals with Disabilities Educational Act, 20 U.S.C. §1400. The information includes name, date of birth, Medicaid number and social security number, and a description of the type(s) of service(s) provided, the date(s) of service and length of service. Disclosing this information to Medicaid and its authorized representatives will not affect premiums, co-pays, or services under Medicaid.

    I am the parent or guardian of ______, a child who has received or may receive eligible services, or I am 18 years of age and have received or may receive eligible services, and I consent, pursuant to the Family Educational Rights and Privacy Act, 20 U.S.C. §1232(g), to disclosure of the information by the schools.

    I understand that I may revoke my consent at any time by notifying the schools in writing.

    I understand that, upon written request, I am entitled to receive a copy of the information disclosed pursuant to this consent.

  5. Tommy doesn’t get TennCare or Medicaid, he has private insurance. However, I remember when this legislation was being discussed and it is not just TennCare being billed, but all insurance carriers.

  6. I need to look up IDEA and review some things but I’m fair certain that any services the school provides they are required to provide by law. Also, the system is economically and resource poor so the system cuts corners when it can and skips or denies services unless a parent fights tooth and nail to receive the services the school is obligated to give.

    So, if the school is obligated to give these services, does that not imply there is a budget somewhere to pay for those services?

    Why are the schools dipping into the coffers of TennCare after TennCare set to the street so many people that truly need TennCare’s services?

    Seems that I need to make a phone call to TN Protection and Advocacy and also do some reading on the Family Educational Rights and Privacy Act.

  7. You have to ask if you have no insurance, what happens then? Are these services denied or truncated in favor of the well-insured? It all seems a little odd to me. And like Doug said, why are the schools taking money from TennCare anyway?

  8. Wow! There is some SERIOUSLY sad politics going on here. So what they are saying here is that money that should be going to the schools is first being filtered through TennCare, because after all, what they should really be doing is simply allocating the funds directly to the school and not through an intermediary that can then “decide” how much of this funding is going to be allowed or how it will be allocated.

    Calls to local representatives (as Doug mentioned) are REALLY in order here.

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