September 28, 2009

Prepared for the fight

After we got the official diagnosis and recommendations from Dr. S, we started bracing ourselves for a fight. We were requesting yet another change from the regional center, this time asking for 25 hours of intensive home therapy, including ABA (applied behavior analysis), speech, and OT. We weren't sure if the new request would be approved, and I started researching what we would need to do to get coverage from insurance.

What I found was appalling. Most insurance companies, it seems, make it nearly impossible to get coverage for these services, considered "educational" rather than medical in nature. One document I read from our insurance company, for example, says they don't cover "experimental or unproven" therapies, such as ABA, even though their own website lists ABA as the autism treatment recommended by the American Association of Pediatrics. They make you go in-network and only to licensed providers, but often only have one provider whose practice is probably full. You get the idea.

Fortunately, our request was approved and our new services are going to start next week. Although I know this is the best thing for Moe, I am a little nervous as to how this is going to affect our family life (and my sanity). I'll be getting the complete schedule later this week, but therapy blocks, which take place at our house, are scheduled from 8:30-10am, 10:30-12:30, and 3:30-5:30. Moe is booked every morning block and some afternoon blocks.

I'm thankful that I won't have to fight the insurance company this time around. I feel for the many families that are fighting on multiple fronts to get the services their kids need. I know many are fighting to get autism coverage included in healthcare reform, and perhaps someday I will be able to help in this fight. For now, I need to devote my time and energy to the work that needs to get done here: helping Moe grow and thrive.

1 comment:

  1. For us, it was one of those happy/sad times when after the evaluation, the county approved full-day preschool. Yes, we're so incredibly pleased with the preschool and his teachers, but at the same time, we obviously wish stuff wasn't so hard for the J-man. So, yeah, especially with the insurance stuff. We only get 30 speech therapy sessions per year on insurance... considering the J-man qualifies for speech therapy twice a week WHILE AT SCHOOL, I imagine that we would be paying outrageous sums if we had to go through our insurance for that.
    Hope it goes well!


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