Thursday, March 19, 2015

Autism - Therapy - Insurance Part 2

Continuing on with my endeavor to obtain services for Emery:

We purchased a separate policy for Emery in February, to be effective March 1st. My goal was to get everything in place for Emery to begin therapies this Summer to minimize school absences. Of course, prior to buying the policy, I learned what was required by the insurance company to obtain necessary therapies for autistic children (speech, OT, PT, ABA). I swear the requirements are there simply to cause exhaustion and intense feelings of being overwhelmed so you do not pursue covered therapies.

The first requirement is we must have Emery evaluated for Autism by an AAEC. An AAEC is an Autism Approved Evaluation Center as designated by Blue Cross Blue Shield. Emery's autism diagnosis from September, 2014 is not acceptable because the center that evaluated her was not a BCBS designated AAEC. There are NO exceptions to the stipulation. Your child's diagnosis is basically invalid as far as BCBS is concerned.

There are a few reasons why this bothers me. First of all, we already went through a 3 step process to have her evaluated. This process consisted of in-depth parent interviews, 3 hours of testing Emery, and a final consultation to provide her diagnosis and recommendations for treatment. Not only did we invest a lot of time in the evaluation process, Emery was already subjected to a grueling testing process.

In addition, the psychologist who did Emery's evaluation is very reputable. Now, I am not just saying this off the top of my head. In fact, Emery's psychologist, Dr. Michael Behen, was previously employed by a BCBS AAEC just two years prior to Emery's diagnosis. He was one of the professionals that performed autism evaluations at the AAEC. He left the AAEC to open his own autism center. In my opinion, going through another evaluation is a devastatingly huge waste of resources.

The AAEC's will not even schedule an evaluation for you until you have purchased your policy. Normally, this would not bother me. Let me explain why it does. There are 10 AAEC's in the state of Michigan. I thought we were really blessed because 2 of the 10 were right here in our home town of Grand Rapids. I called Helen DeVos Childrens Hospital first, simply because it is closer to my house. Guess how far HDCH is booked out for autism evaluations? Six to Eight months! On top of the 3 to 4 week evaluation process, it could be an entire 9 months before we can even think about therapy for Emery. Ugh! Keep in mind, we are Paying $300 per month for the insurance policy during this time.

So I then call Pine Rest, the second AAEC in Grand Rapids. Pine Rest is booked out a full 8 months. I am now beginning to once again feel helpless and hopeless. I decide to call the University of Michigan Autism Center is Ann Arbor. Not that Ann Arbor is close to us, but it is probably the next closest AAEC. This facility is booked out 12 months. Really?

Why in the world would the insurance company make us go through an unnecessary autism evaluation, when timely performance of the evaluations cannot even be provided? Why should Emery and countless other children with autism diagnoses be denied the medical care they so desperately need? What ever happened to the "Grandfather Clause"? If a formal autism diagnosis has already been received, why must we waste valuable resources to obtain a second diagnosis? If BCBS wants to designate what facility performs our child's evaluation, that is fine for children who have not already been evaluated and diagnosed.

If BCBS wouldn't disregard already obtained diagnoses, there would be a much smaller backlog of children waiting to be evaluated. Instead of wasting another year, these kids could be receiving treatment. Now maybe another backlog would be created because there are not enough therapists available to provide therapy. But, at least, our ASD child would not be subjected to another evaluation.

I decided to call another AAEC in the Detroit area. This one, the University of Pediatricians, was able to schedule our initial appointment in June. This appointment is only attended by the parents. One week later, Emery will be evaluated. Three weeks later, we have our final appointment to receive this facilities diagnosis and a therapy plan specific for Emery. Yes, that is 3 trips, back and forth, to Detroit. We will at least have a plan in our hands on July 7th, providing a diagnosis of ASD is given. This will hopefully allow us to get Emery started in an intensive therapy program.

My goal was to start therapy the second week of June. We actually will not get started until after July 7th. But, I think going to Detroit rather than waiting several months to even get an evaluation is a better option for Emery. She is not a typical ASD kid. She wasn't diagnosed until she was 9 1/2 years old. She never had early intervention services. We need to get her going as soon as possible.

I did contact HDCH a second time to see if Emery could be put on a cancellation waiting list. This was an option. I first had to have Emery's pediatrician send a referral and then they would contact me. When I contacted the peds office, they told me HDCH is now over 12 months out on scheduling. The peds office sent the referral off immediately. That was over 2 weeks ago and I still have not been contacted by HDCH. I will be calling them again to try to get on the cancellation list. If an appointment were to open up for Emery, it would be nice to make three 10 minute trips rather than three 3 hour trips! I'm not expecting it, but it can't hurt to try.

That is my story pertaining to autism, therapy, and insurance. Definitely a challenging situation. Praying it eventually works out in the end. But, I am learning to be cautious with my hopes and to expect setbacks. All we can ever do for our ASD kids is to keep trying. I will never give up on Emery. I know she has potential given the right therapies. Getting these therapies can be a frustrating and time consuming process. Emery is worth it.





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