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Archive for the month “April, 2012”

Part 2: Navigating Insurance and Figuring How to Pay for Therapy

I was supposed to go to class after Ingrid had her assessment.  I was too overwhelmed to even think about sitting in a room with other woman and having to listen to an instructor teach.  Nothing against any of them but I was in this state of really wanting to be alone.  I was having a range of emotions flowing through me at the same time that it felt as if my own skin was crawling.

When I got home I just sat with Ingrid for a little bit.  I started at her wondering what her future would hold.  I knew that my job as a parent was to do everything; anything to give her the best opportunity in life.  I decided that for my own sanity I needed to just take a week off from the worrying and focus on my family and making sure we were all still doing what we normally do before I started to figure things out.

For that week I put the packet that I received from WEAP off to the side.  Instead, I made sure to play with Ingrid and have the two of us just experience each moment while we were in it together with no worries.  It was beautiful.  When Ingrid would get upset or do something unusual I would find myself thinking, “is this normal?  Is this what a typical two and a half year old does?  Or is this the Autism?”  I would find myself obsessing over things like this.  As if Ingrid knew, she would come up and give me a kiss or a huge hug or laugh one of her best belly laughs to snap me out of the obsession.  It felt good.  It felt right.  It felt normal.

After the week passed I decided to get working on all the paperwork and calling my insurance.  I filled everything out and returned it to its rightful office.  Next, I called my insurance company.   Made sure to call later in the day when there weren’t so many people in the office.  My immediate co-workers knew for the most part what I was going through but I was nervous that I would break down if I ran into some issues about getting my questions answered or being told news that I did not want to hear. 

I called the number on the back of the card.  I get the really annoying automated woman asking what I am calling about.  So I state my business.  This machine tells me they did not hear me so I state it again.  It goes through more questions with me and most of them I have to repeat my answers.  I am growing rather weary from this.  I finally get transferred to a live human.  I explain the reason for my call, I give them my insurance card ID number, verify both mine and my daughters date of birth and our home address.  I get told they can not help me and I get transferred to another department.

I speak to the next person.  I go through the whole thing again reason for call, my date of birth, Ingrid’s date of birth, mailing address, insurance ID number and wouldn’t you know it; I have to be transferred again.  I take a deep breath, say OK, no more questions and get transferred to another area.

Finally aftyer a few misnutes of being on hold I get my third person.  She is really sweet sounded.  I go through it all again; reason for call, date of births for Ingrid and I, our address and the insurance ID number.  The woman confirms I am in the right area.  I celebrate in my head this small victory.  I explain to her about my daughter being just diagnosed with Autism Spectrum Disorder and the recommended therepy is Applied Behavioral Anylasis or ABA.  They look through my policy and state that my policy does not cover this. 

Luckily for me WEAP gave me a sheet of questions to ask.  So I start to go through them:

                Is my policy following the Wisconsin Autism mandate?

                Is in-home ABA therapy covered on my policy?

                Is this policy based in Wisconsin?

Is this a self funded policy or an administrative serviced only policy?

I am told that my policy is self funded there for they do not have to follow the Wisconsin Autism mandate and they are only required to cover what ever the federal guidelines are.  There for my policy does not cover the ABA therapy.  So I ask what they Do coverage.  I am told that they cover individual and group psychotherapy.  I explained that is of no use since my child is two and a half and non verbal.  Talk therapy is not really an option.  So I ask one last question:

Is the lack of coverage based on what my employer chooses to cover or what my insurance company offers?  I am told that the option to cover ABA therapy is left up to the employer.

Thanks for the information I say and I hang up.  I can feel the tears filling my eyes.  I wipe them away and take a deep breath.  I convince myself this woman has no clue what she is talking about and I will call back in a few days and speak to someone else.

I did this.  I got the same response. 

No my sadness was turning into anger and rage!


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