Thursday, March 28, 2013

Rant: It's short I promise

I never wanted to use this site as a ranting platform; however, my emotions have the best of me today.  I promise to go back to my positive outlook after I get this off my chest. 

Yesterday in the mail I received a letter from Highmark Blue Cross Blue Shield, our current health insurance company informing us that they will no longer be covering my aspie's therapies; including and not limited to occupational therapy (where is works on writing, using utensils, putting his clothes on himself, using buttons, etc) and speech therapy.  They have deemed them "not medically necessary nor appropriate" for a child with Asperger's or High Functioning Autism.  What the ????  After endless phone calls, I finally was able to speak to someone from Highmark to start an appeal process.  She informed me that Highmark themselves does cover autism services; however, if their underwriting company Healthways WholeHealth denies the authorization, then they will not cover the services.  That it is not Highmark saying no, it is Healthways saying no.  So let me clear this up for everyone who is as confused as I am.  Highmark does not want to dirty their name and wants to be the jolly insurance company who can state that why yes, we do cover autism services, and then turn around and point the fingers at another company who will not let them.  Guess what Highmark, I see right through it.  If you hire someone to do your dirty work for you, you are just as dirty. 

To make matters worse, they gave me less than a week before they will be dropping my aspie's coverage for the therapies.  And although I can file for an appeal, and have begun to do so, it seems like this is just a formality to get you more time to find other means to provide therapy.  The girl from Highmark also suggested I contact my welfare agency to apply for Medical Assistance.  In other words, have the state pay because we ain't gonna.  I informed her that I have applied for MA four months ago and still have not heard anything even though I have called every week for an update on the process and had to recently contact our state representative to see if he could help us with the process.  (Apparently, living in the third poorest county in the state of PA makes it a little harder when applying for state benefits.)  She had no comeback for that except, well okay mam, this is all you can do now and we will let you know about the appeal in thirty days. 

Luckily, our therapy center is very wonderful and will hold my son's time slots for four weeks hoping that we can get this straightened out before then.  And yes, we could pay for his therapies out of pocket, which would be $135 per session and he goes three time a week.  But, $405 a week would literally break us right now.  If it looks like it will go longer than a week or two we will pay for maybe one a week until something can be resolved.

Maybe Highmark and other insurance companies should think of this. The latest statistic is that 1:50 kids will suffer from autism. 90% of adults with autism do not work and live in group homes or with parents. Insurance companies make money from claims and for the most part employers purchasing the insurance for their workers. If they deny the therapies for the kids of today, with the diagnosis rate being this high, the unemployment rate of adult with autism in the future will not drop, meaning employers will have less employees paying into insurances. That means, of the ~291,000 children born in 2012 in the US, roughly 5000 of them will have autism and will not be able to work. That is a LOT of people not paying taxes, not contributing to society, not doing anything because some CEO, CEOO, or some board of trustees did not want to pay for therapies because they were "medically unnecessary". Is my child going to die if he doesn't go to BUT he can't go out in public without hiding; does that sound like a future employee to you? Is he extremely smart....yes. Can he talk to someone to let them know how smart he is....NO!! Does that sound like a employee to you?  If you are wondering where I got my numbers from, it's from and the, check it out and do the math.  Scary. 

Okay, I promised this would be short so I will stop it here.  If you see a lot of grammar errors, its because 1.  I am writing this mad and 2.  I am posting this without my husband reading due to my mad fury.  I wanted to post it during my high emotions because it is one of the ugly sides of autism.  The side that is not covered on the evening news, on commercials on TV,  or even in the Sunday newspaper.  This is the story that thousands of families are dealing with everyday, fighting their fight to do everything they can do for their kids.

****The month of April is autism awareness month.  On April 2nd, countries around the world will light it up blue to bring awareness to autism and everything that goes with the diagnosis.  Places like the Sydney Opera House, the Empire State Building, the White House, the Eiffel Tower and my home will be blue in honor of the Autism!  I urge you to please wear blue, paint your fingernails blue, switch your porch light to blue (Home Dept is carrying the Autism Speaks blue light with proceeds going to them), or whatever you can do to show your support for Autism and bring awareness to this syndrome!  I will keep reminding everyone with future posts as well!  Thanks for reading!!!****


@dkotucker said...

Gah...I'm so sorry to hear this Lisa. :(

I hope things will get resolved in your favour quickly. Sending positive vibes your way.

Hang in there! D

Lisa Lohr said...

I need positive vibes!! I have been all angry the last two days! Hoping it will get resolved soon though!! Thanks D!

Sarah said...

I know this doesn't address the underlying issue of crap-face insurance companies, but...

I work in Toledo, OH and work at a center that has a very strong autism program (OT and Speech, etc) I don't know all the details, but I do know there are different local and state scholarships that they work with to help their kids (parents) along. I can't even tell you where to start. (I'm an audiologist and only work there 4 hrs a week, I'm contracted and don't know a lot of the details).

It's definitely a shitty situation, and one I would continue to fight, but in the mean time I just wonder if there are some type of scholarships available in your area.

Good Luck!

Lisa Lohr said...

Thanks Sarah! I will look into that!