Monday, November 8, 2010

Wanna Hear A Funny Story?

Our insurance company (ha! I made a typo at first and wrote 'sinsurance') wanted us to have a conference call with them this morning.  They gathered some big wigs in the room like their clinical social worker in charge of the 'care' management team, a senior care manager, and a doctor from the Bay Area who is a board certified child psychiatrist and director of behavioral health.  The purpose of the call was for them to give us suggestions that we may not have already come up with to better our child's health.  (HAHAHAHAHAHAHAHA)

So we discuss the speech and occupational therapy we're doing privately and at school.  Child psych agrees this is a good thing.  (gee, thanks)  Child psych then says that he noticed that in the last seven years we have not yet seen a child psychiatrist.  I had been concerned that this man would 'advise' us to seek medication for M, so I asked him straight out if that was his point.  He responded by saying that he didn't necessarily agree medication was always the right thing and couldn't comment specifically on that since he hadn't met our son.  Good man for saying that because I'd a pulled out a can of whoop ass if he had!  But he said that a psychiatrist would advise us on other behavioral interventions.

Wha??  Stop right there, doc.  So I said to him (in my best lawyer-esque, leading question, sort of way) 'exactly what other behavioral interventions could you mean??'  I'll give you one guess what he said.......

Wait for it....

Applied Behavioral Analysis!  The very reason we were having the freaking call!  Because the stupid-ass insurance company believes it to simply be educational and not worth of covering.  Anyone else find this ever-so-ironic?

They took it one fabulous step beyond that and let us know that they'd been awesome enough to do some research for me and found a provider who would charge us a lot less than our current provider had.  Of course, this would come from our own pockets, but aren't they so great to have done all that legwork and made all those phone calls for little-old-us?  Wow, I am so honored.

I made a point to remind them that the only reason we'd gone with the provider we had was because at the time they were the only ones in-network, which was their requirement.  I also made a point of reminding them that the reason our therapist was more expensive than most therapists was because they required her to be of a higher accreditation.   Funny, no one said a word after that.

We let them know that we'd be starting the tedious appeal process immediately knowing full well they're going to deny us at first.

What a joke.  What a freaking waste of our time.  $#@(**!!

5 comments:

starnes family said...

Ugh. I don't have near the need you do regarding insurance, but the few times I've had to deal with them, I almost pulled my hair out. I wonder how dr offices deal with them day in and day out.

Thinking good thoughts!

Paul and Kerry said...

cheezus! how nice of them to want to save you some money for the therapy they should be covering. what a waste of time and "resources" on their end.

Boy Wonder's Mom said...

Ummm can I call them assmunches on here?

Perhaps the bigiwgs should've told the child psychiatrist to not mention ABA? Morons

Boy Wonder's Mom said...

let me clarify,(sorry) Perhaps the child psychiatrist should NOT have mentioned ABA, If they were trying to cover their own butts for not paying for M's ABA!

MothersVox said...

Found you on Hopeful Parents site and want to say hang in there. I know what you mean about having to fight for every.little.thing. It is exhausting. It is almost as though sinsurance companies are set up to insure that our kids don't get the care they need. Love your typo.

Our girl does take some medications, and even to have those Rx'es renewed took seventeen hours one January not long ago. http://autismsedges.blogspot.com/2009/01/hidden-costs-of-mismanaged-care.html

It's ridiculous. Maybe autism parents should be camped out in the lobbies of insurance companies offices with our kids there, freaking out, because they have not received the evidence-based treatments that would help them. Perhaps that would be enough of a demonstration of the need for coverage.

We have finally gotten our insurance company to cover, modestly, in-network speech therapy. Whoo-hoo. That took eight years.

And yes, it is exhausting when you look at people who don't have these challenges and can't even imagine what your day looks like. Some of us can.

Hang in there. It will be worth it because change happens, for your child and in the wider world.

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