I'm Mad

iVillage Member
Registered: 11-24-2003
I'm Mad
5
Fri, 05-13-2005 - 4:14pm
I am sick and, tired of all of the hoopla I am having to through to get Maya's speech and OT approved through our insurance(BLUE CROSS AND BLUE SHIELD). This is really redicules. the letter said "the member has a chronic developmental delay which speech and OT will not restore or improve in a period of 62 consecutive days."WTF?????? If she was a kid with cancer they wouldn't deny her chemo because she may or may not get better in 62 conesc. days. I am fighting mad. Every day Maya does not have these services she slips further and further away. My sister wrote Oprah about it Maby we should all unite and write her our stories. Maya was diagnosed with PDD mild. I know some people have it worse but, I can't afford to pay it all out of pocket. If Oprah hears about ti mayby she can help us. I know I have heard of a lot of other families with the same problems we are having.
iVillage Member
Registered: 01-19-2005
In reply to: mamatonate
Fri, 05-13-2005 - 4:34pm

I just wanted to say I know how frustrating this is. We had the same response from AvMed. It is ridiculous, but common, I am afraid. At least AvMed will cover all his medical tests and doctor visits, but not the therapy either. They cover diagnostic things, but don't consider any therapy viable (even ABA). They say it is all "experimental."

I have two letters that I'd love to send to Oprah too. The ones just like you described from AvMed that said "can't be cured in 62 visits" and then the opposing point of view from our early intervention program which dropped our son from services before he turned 3 because he was doing TOO WEll! A year of ST had brought his vocabulary almost up to his age level, although he still has many pragmatic problems. You have to laugh (or cry!).

Speaking of early intervention, I am trying to remember how old your daughter is, is she under 3? If so you can still do early intervention until she is 3, and that will be free. In South Florida the list of participating providers was good.

But after 3 everything changes! As we discovered. I wish I had better advice but our fights with the insurance company only made us tired and mad.

Katherine

iVillage Member
Registered: 11-24-2003
In reply to: mamatonate
Fri, 05-13-2005 - 4:55pm
SHe is twenty months. I did go through EIP when she was twelve months and, at the time they reccomende speech and OT on time a week. Then the OT did kind of what your's did and said "Well, you are working so well with Maya I don't see any further need for me." Then, a month ago we went to Dan Marino and, they said speech an OT 3X a week. We found a great place to get it done but, part C is giving me a fight from hell because there speech and Ot s did not deem it nescecary at twelve months. THe center Maya will be going to does accewpt part C but, they really get on my last Darn nerve. They are quite the opposite of helpful and, considdering I pay 840 a month out of pocket for the insurANCE THE LEAST THEY COULD DO IS COVER THIS. to ME IT REALLY IS THE POINT THAT MY PRIVATE insurance should cover it. I should not have to have govt. approval to get my daughter the services she needs when I shouildn't have to use their funds because I have my own stinking insaurance. To me it is like telling a chemo patient "sorry you're insurance company has opted not to pay so, here the govt will foot the bill" and we wonder why AMerica has so many money problems AAAAAAAAGGGGHHHHH. I don't mean to get on a tangent just, letting off some steam.
iVillage Member
Registered: 01-19-2005
In reply to: mamatonate
Fri, 05-13-2005 - 11:43pm

It's okay to vent, that's what we are here for! I totally understand. We've been paying out of pocket for speech 2x a week since he was dropped from EIP until we get his pre-school situation sorted out. I thought I could do the OT at home, since we could only afford one of the therapies, and I have been doing it. But I am not a professional and we can tell Eric has regressed a bit. We are considering springing for the OT somehow and like you say, it isn't fair since we too have what we thought was good insurance!

We go to the Dan Marino Center too, and we live near it. Provided we get what we want from the public school/IEP process for Eric, we hope to take what we were paying in tuition for private pre-school and use it towards the OT.

Vent all you want. I remember a doctor friend of mine whose child has autism tell me she almost wished he did have cancer (not literally, of course) but she said like you that if that had happened, at least all the therapy would be covered by insurance, no matter what. I know how you feel and it isn't fair. We shouldn't have to fight for services or have to make choices for therapy based on finances. But I guess in the last year I've gotten a lot tougher and learned how to fight with regard to school issues. Still, it is not fun and not fair. With insurance companies, however, it seems impossible to get anywhere.

Katherine

iVillage Member
Registered: 03-26-2003
In reply to: mamatonate
Sat, 05-14-2005 - 12:38pm

Ya know your post reminded me of this thing I had gotten at the last parents symposium in our area. It was a letter from a doctor who's son had BP. It said he would rather his son be diagnosed with leukemia then went on to explain why. It was very moving and mentioned alot of the differences of how insurance, friends, family, community, etc where there to help provide the neccessary treatment for the child, but a child with BP was not. There are limits on insurance and most friends, family, etc run away.

I was having this discussion with a few others recently and not just about autism. Not only are there tons of things not covered by insurance, but it is offered at such a horrible rate that it is unavailable to most people of moderate means. Most therapies I would rate near highway robbery. All 4 of my kids have various needs. To get them the supports that would really be most beneficial for them at a young age would costs me more than what I could make per year. Plus I stay home with them because all the appointments, IEP meetings, school volunteering and running of everything neccessary makes working impossible.

Instead, I just do the best I can. Do what I can do at home and pray that overall they will turn out ok.

Renee

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iVillage Member
Registered: 12-22-2003
In reply to: mamatonate
Sun, 05-15-2005 - 6:51pm

I have to put my two bits worth into this one.

We, too, have BlueCross/BlueShield and it's absolutely horrible insurance. Right now, we're waiting on pins and needles to see if they will cover two days of testing for Claire that I finally managed to get set up with the ASD clinic. (18 months on a waiting list, it finally took a call from my "VIP boss" to the CEO of Easter Seals.) The total cost will be $2300...and WHY is it necessary to go through this? Because our school district is so underfunded that I have to beat my head against the wall to get her the services she needs.

She's been in a spec. ed. preschool through the district since Feb. of last year. Even with getting OT once a week, she still has nothing even remotely close to a "mature pencil grasp"- to be honest, she refuses to hold a writing. That should be great in Kindergarten, don't you think??? So I ask for more one-on-one OT time, she doesn't get it because the school district doesn't have the resources. We're hoping that we can put the "Fear of Easter Seals" into them and get her into a mainstream classroom with a full-time aid.

Sorry...just had to vent for a minute. Feel much better now. (Okay, not really...but at least I know I'm not alone!)

Amy W.

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