I hate those two words. They make my blood boil! Who is to say what is and what isn't medically necessary. The insurance companies, that's who!
Poor Tim has been trying hard to get ahold of our insurance company to see just what we will be covered for with Wes's therapies, neurologists, nutritionists, ect. Well they can't give him a straight answer. He might be covered for this and might not be covered for that. We don't need a referral, but we might want to get one so that it will be covered more. AARRGGHH!
I don't need more stress then I already have. Why do they have to make life more difficult for people. We pay a lot of money every week to insurance only to be told "sorry, too bad". What good is it?
I want Wesley in speech therapy. He already has Occupational Therapy and will be seeing a Behavioralist soon, but he really needs help with his speech (or lack thereof). Well that is one of the mights. He might be covered and they want us to ask the therapist we plan on taking him to if they have ever given therapy to a child who has autism and has this specific insurance plan. WHAT!!! Aren't they supposed to know this?
We don't have the extra money laying around to pay for these therapies out of pocket. What are we supposed to do? I want the best for my son and give him every opportunity to thrive and become a functional human being. Of course it's medically necessary for him to have a ST (speech therapist) because the kid is LACKING IN HIS SPEECH! It's part of the Autism and not because he is just lazy. Do you think people just send their kids to these kinds of therapies because it's fun? I would love it if Wes could communicate with me and didn't need any of this, but the reality is, he does.
Wes has a problem with chewing and swallowing his food. They think that the muscles in his mouth are immature which could also be the reason for not being able to form words. All insurance will pay for is 4 sessions in one year. Yeah, because that's enough to teach a child how to chew and swallow properly.
It looks like we're going to have to start taking out loans already just to pay for our child to get through life as normal as possible. We're only 4 weeks into this and I'm ready to blow up the medical communities out there. Powerball, here we come.
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It's been nearly 9 years since my last post. Wow, have things changed! I'm not sure why I stopped posting to my blog. It was mos...
2 comments:
Jess,
Please let me help you. Karen Livernois can cut through some red tape for you. She can help smooth the frustration for you. If Wes is a patient at Community Bridges you should have a family case worker. Our OT helps us with all things related to our family - not just Carter's OT care. The road you are going down can be so much smoother. CAll ME. Please don't go it alone. Love Kelli
Hi, I just started reading your blog, so sorry if this was already covered, but can't he get ST through E.I.? My dd has been in speech since 18 mo, til she aged out and now gets it through preschool. Is that available to you?
Before e.i. we did look into private therapy, but were told by our ins unless our dd had a physical issue, like cleft palate, they didn't cover speech...grrr...
Jen
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