I have heard and read about much debate about the subject. So much disagreement, arguing and in some voting districts people are passionate enough that I am sure, depending on the outcome of the upcoming vote some people in Congress could get voted out office!
The thing I DO NOT understand is, no matter your political, personal or religious reasons there is NO denying health care MUST be reformed. The way to reform it is up for debate but the fact that it must get reformed MUST HAPPEN!!Now I add a personal story and experience to this newly crowned top of every party political platform - health care reform.
My son has a mental disability. Due to his disability of autism he is on what is called Arizona Long Term Care. It is paid for by the State of Arizona by the Department of Developmental Disabilities (called DDD) it provides medical insurance and is what pays for any therapy and "treatment" for autism.
A couple things have come to my attention and it makes me want to pull out my hair, scream, yell and shout at someone.
Here is some background information so you can all have a taste of my frustrations:
Brody's support coordinator at DDD had to approve more hours of habilitation and respite for Brody for the new year (for him it is every February). (FYI: respite is extra care of children with special needs and habilitation is an extremely important service with a therapist or care provider that works on very important and specific goals with Brody to help him catch up to wear normal-functioning children his age are at). Since Brody was previously approved for hours from just October (that is when those services started) to February he had a pretty good amount of hours with no problem. Not the case now. Brody got about a third of the hours he was getting. To ask for the current hours would be too much we were told. The reasoning is that Brody is still really young and these goals that he is working towards in habilitation could be helped along by his parents. That is true if he were any other child but since he has a disability I don't know how to teach him social skills, to follow directions, talk more, understand more, etc. The person that is his care provider has worked with special needs children for about a decade and has education and training. How can I compare to that?? I have the option to appeal (which I might do). If I want more hours approved, it would have to go all the way to me and Jake making our case to the head of the medical department of DDD!
In November Jake and I put Brody on Jake's health insurance through his work at University of Phoenix which is United Healthcare. Even though he has health insurance through long term care the insurance won't cover for Brody to go to a DAN (Defeat Autism Now) Doctor who practice naturopathic medicine (most health insurance companies won't cover those doctors) and specialize in treating children with autism. Brody has some immune and gastrointestinal issues so he was a great candidate for this type of treatment. The office manager at the doctor's office who processes all the insurance and payments told us that no our insurance wouldn't cover it but other patients there with United Healthcare and other insurances most of the time are able to get reimbursed. The doctor just fills out a receipt with an insurance code not for "autism treatment" but gastrointestinal issues.
The same month Brody was put on the insurance we took him to the new doctor (who we love and he also has a child with autism so it feels great to relate). He is expensive initially and with some of the supplements, lab work and follow ups for new treatments. After each doctors visit I made a copy of the receipt and mailed it in with not a word in response. I mailed all the copies again at the beginning of the new year with a letter asking for at least a response. At this point we have spent hundreds of dollars in just a couple months.
Since we got the news from DDD about Brody getting less habilitation hours I though perhaps some of the hours could just go through his health insurance cause it is seen as "treatment" for autism. My first call to the insurance I got a, "no, there is no coverage for autism". After hanging up I thought it was weird cause in the back of my mind I remembered in my autism research reading about a bill that was passed. I looked it up again on the Internet to know the facts: Arizona House Bill HR2847 requires insurance carriers to provide coverage of evidence-based, medically necessary autism and therapies. So I called the insurance back and throughout a day or two and 3 or 4 different people (cause they wanted to make sure I had the correct answer) found out that because the insurance is purchased through Apollo Group (who owns University of Phoenix), even though we pay Apollo Group for the insurance, the plan we are under doesn't have to follow the government mandate that is HR2847 passed in 2008!!!!!!!!!!! How is that even legal! It is a mandate and somehow there is a loop whole. Yes, that makes me scream.
Oh and while I had them on the phone I asked them about my many claims I mailed the insurance about Brody's treatments at the DAN Dr. I was told the doctor was out of network.
My son is locked in a world of autism. He is just waiting to rescued and longing to talk and tell me what he is thinking. But Brody might not be able to break out of that world as soon as he could because this short window of time, when he is younger and the walls of autism is thinner we, as his parents, at ever turn either don't have enough money to pay this doctor who has already helped or a therapist who has already seen improvement. There is this wonderful thing called insurance that is suppose to help when times get tough and someone doesn't have enough money and since they pay for this insurance every month it shouldn't be a problem right...no, there are enough loop wholes to help these insurance companies get out of certain responsibilities.I guess the state of our health insurance in this country is okay...if you don't really need to use it!!
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