North Texas Families Denied Insurance Coverage from Pediatric Therapy Center

Inside Beelieve Pediatric Therapy in Fort Worth, every step is a milestone for five-year-old Lola. Lola lives with a rare neurological disorder called Angelman syndrome.

Thanks to therapy she can now walk.

“This is life-altering for her,” said her mother Chelsea Guido. “This is giving her a quality of life that she would not have.”

It’s the same for six-year-old Dylan. Born with cerebral palsy, Dylan has been seeing therapists at Beelieve for the last five years and gaining new skills through consistent sessions.

“So he can walk, he can feed himself, he can use his hands so he can color and write, just do things that every kid wants to do,” said his mother Taylor Whitson.

Now, these mothers say their children’s quality of life is in jeopardy. Their Cook Children’s Health Plan is suddenly denying coverage for therapy at Beelieve. It goes against the advice of the children’s own doctors at Cook Children’s Hospital.

“It was incredibly shocking because all of the doctors within the Cook Children’s network are the ones that recommend it,” Whitson said.

Beelieve provides physical, occupational and speech therapy all under one roof. The mothers tell NBC 5 that finding a clinic that offers all three is rare in North Texas.

Beelieve is also one of the few places to offer intensive therapy – an option that allows children to come three hours, five days a week for three weeks to help them achieve new skills.

The repetition helped Dylan learn how to feed himself.

“If it wasn’t for intensive therapy it might take six months to a year for Dylan to gain the same skills that he gets in three weeks in intensive therapy,” Whitson said.

In his five years of coming to the clinic, Dylan has taken three intensive therapy sessions.

In a statement to NBC 5, Cook Children’s Health Plan said its decision to terminate coverage is final, citing safety concerns around the therapy.

At Cook Children’s Health Plan (CCHP), we strive to keep quality and safety in mind above all else. Ensuring our members have access to safe, reliable and effective care is our highest priority.

We terminated our contract with Beelieve Pediatric Therapy after CCHP identified cases where experimental and investigative approaches were used, which could potentially harm patients. Many of these children are very young, with disabilities and/or without the ability to communicate, which often makes it impossible for them to effectively communicate significant levels of pain or stress. We worked for months to try to make this a workable situation for all involved and at the end of the day we had to make the best possible decision for the safety and well-being of our members. After careful consideration, CCHP made the decision to terminate this arrangement and our decision is final. We have contacted all impacted members to help them locate new therapy providers who are in-network with our plan. CCHP members who have questions about their plan are encouraged to call 1-800-964-2247.   

We recognize the frustration this has caused the affected CCHP member families, and our team is working quickly to identify safe and qualified therapy providers for all impacted members.

The mothers tell NBC 5 their pleas to reconsider the decision have failed and they’re faced with few options for their children. The decision they said affects more than 100 families in the Tarrant County area.

“They are taking away a very essential part of my child’s healthcare and the quality of life,” said Guido. “You’re not just taking away a service, you’re taking away a family, a home that is a safe and loving environment for children who don’t always get that.”

In a statement to NBC 5, Joanna Littler, Beelieve owner and physical therapist, says intensive therapy is well-known and done only in agreement with the child’s physician, adding their therapists have never put a child at risk.

A GoFundMe account has been established to help families cover the cost of out-of-pocket care.

Read Beelieve Pediatric Therapy's Full Statement Here:

Intensive therapy is a well-known therapy model utilized at more than 100 places across the country, including multiple children's hospitals - such as Texas Children's in Houston and John Hopkins All Children's Hospital. All modalities used in these sessions are backed by research, including research completed by the National Institute of Health and the FDA. No intensive therapy is done without a physician referral, who is not only in agreement with the frequency and duration of the sessions, as well as the modalities used but oftentimes it is Cook Children's physicians themselves recommending the intensive therapy for the children as they have seen the amazing results achieved with this type of therapy.

Our therapists are all trained in reading nonverbal cues that can identify levels of pain and/or discomfort and most of the time, the child's parent, nurse and/or caregiver, that knows them better than anyone, is present in sessions and also available to identify if they have pushed to a level of stress. Each of these medically fragile patients have achieved significant gains during intensive therapy and their parents, doctors and therapists have all been pleased with the results. The families have all been ecstatic about the progress their kids have made during intensive sessions; oftentimes achieving a skill that their doctor never thought possible. Nothing that any of our therapists has ever done in ANY session has put a child at any risk or danger, but instead fulfilled our mission of helping all kids BEE the BEST they can BEE! 

In regards to 'working for months to make this a workable situation', this has included: 1. A phone call in September that I initiated with the health plan where we agreed that the health plan would not financially approve 5 days/week of therapy. I asked if I could continue to offer this therapy that constantly improves kids' quality of life, and they agreed that 'yes' I could still treat 5 days/week, but they would only reimburse 2 days/week. On this phone call, I requested the Medical director, authorizations department and all others involved in this decision to come see intensive therapy firsthand, however, they all declined. 2. CCHP sent a letter to us November 1st summarizing this phone call and we have seen 3 CCHP members for intensive therapy since then. We have submitted ALL documentation and paperwork they requested and we have billed the health plan for 2x/week and written off the other 3 days. 3. We heard nothing else from them until our families started calling us on March 10th informing us we were no longer in network with CCHP. We have also continued to see our other 135 patients that have CCHP for physical, occupational and speech therapy sessions 2x/week. If the health plan did not want me to continue doing intensive therapy with their members, they could have required that; but they did not and now 138 kids are being penalized for something out of their control. 

In conclusion, CCHP did not make this decision because anyone was harmed or complained, but simply because we offer this type of therapy to 10% of our patient population; however, now all 100% are no longer able to utilize our incredible services. We have requested a face-to-face meeting on countless occasions to further discuss, however, they continually refused, stating, 'our decision is final'.