Friday, June 15, 2007

Insurance

We are thoroughly immersed in the world of moving - packing, sorting, panic-ing - all the fun stuff that goes along with upheaving your life and saying goodbye to lovely people. T is very interested in the change in our garage - no cars but lots and lots of boxes! It's an endless source of fascination for him, and I'm glad that we haven't run into too much anxiety on his part - yet!

News on the insurance front: our health insurance company has denied coverage for T's speech and occupational therapies. Their reasoning: these services are considered "educational" since he never had these skills. They only cover "rehabilitative" services - so if he had speech, then lost it due to an injury or illness, speech & OT would be covered. "So he's just supposed to stay non-verbal and unable to dress or care for himself??" I asked. It's simply not covered on our plan. Criminal.

The ray of hope is that I called in January (when we started him on this new insurance) and asked specifically if speech & OT were covered. I was told that it was. So we kept him going with weekly sessions at the local hospital's therapy clinic, only to get bills totalling (as of today) over $5,000.00 for his therapies. They have given us a one-time administrative exception form Jan-March because I was told that speech & OT were covered, but they won't cover April. That's just $1,007.00. JUST $1,007! Great scott. I called today to explain that they need to cover April as well. It is not right to expect us to pay over $1,000 out of pocket when they have acknowledged already that they were in the wrong. They weren't going to budge, but then I pulled out the trump card: Indiana has an Autism Insurance Mandate which requires treatments for autism to be covered. What they are doing may actually be illegal in Indiana. They are looking into this and will get back with us in 2-3 business days. Yes, and I have the Indiana Department of Insurance complaint form bookmarked and ready to fill out. I spoke with them last week and they said that it sounds highly suspect.

I'll keep this blog posted.

So many reactions, though...insurance didn't cover ESSENTIAL therapies for our son. He is one of a tsunami of children diagnosed with autism - what is going to happen next? Will insurance deny even more because it will simply be too expensive? What sort of premiums will we have to pay? Why didn't our therapy clinic know about the mandate? Why am I navigating this myself?

I knew I was going to have to learn to fight, really fight for him. I just didn't think I'd be doing so much fighting before he was 6!

1 comment:

nonie said...

Even though I hear about your journey with T I wanted you to know I read your blog and admire and love you for all that you do and are. I know things will work out and the challenges are endless, but you have support available from those who love you.