Thursday, March 14, 2013


We are going insane with the insurance company who holds Anthony's policy.  I didn't know this before, but once a child with autism turns "school aged", BOY OH BOY do they come out of the woodwork to ask you, um, how's your child with autism doing?  Still has the autism, does he?  Does he want to take advantage of the FREE and PUBLIC education to which he is entitled?  No?  How come?  It says in this report from his school that he is "doing better" and that he is "communicating with pictures".  Sounds great!  Off to school with him, then!

To them I say GO TO HELL, SCUMBAGS.  Every six months we take Anthony to his developmental pediatrician, who PRESCRIBES ABA therapy for 40 hours a week.  The only place he can get ABA therapy, which is PRESCRIBED by a DOCTOR, is at the school where he is now.  If he goes to public school, they can't fill the prescription.  Why is this complicated?

Apparently, the insurance company wanted a "transition plan" included in their last evaluation from Anthony's school.  They didn't get one, so one is to be included in the next report.  What I want to know is why?  Why do we have to tell the insurance company about a transition plan?  Why isn't the prescription for ABA therapy enough?  The doctor prescribes ABA therapy, the ABA therapy center fulfills the prescription, we pay our ever increasing premium, and the insurance company pays the rest.  What the hell?  Why is it different because he has autism?  It's not.  It shouldn't be.

The letter that we got, stating that they were denying part of his plan, is signed by a doctor, a medical doctor.  She could be a freaking generalist, for all I know.  I'd like to know if she took the same oath that everyone else took, the one that mentions "do no harm".  I'd like to know how much money she is paid to sign off on letters like this.

I know.  I know he is a bad risk.  I know he is only covered because we live in Indiana, one of 34 states that has an autism mandate.  But you know what I say to insurance companies that are mad that they have to actual lose money on some kids?  TOO BAD.  I have been paying into medical insurance for all of my adult life, and my parents have paid into my health insurance before that.  I've NEVER been without medical insurance and I've never been sick, barely.  The only time I've been in the hospital is when I had my kids, which I suppose costs too much too, I guess I should have only had the recommended 1.3 kids or whatever.  But TOO BAD!  They are supposed to cover the costs of his care and I am supposed to pay the premiums.  Why is some asshole MD from the INSURANCE COMPANY saying what care he should get?  That is going to override his doctor?  It's unreal.

We have to keep trying and fighting but sometimes I am tired of it.  Most of the time I am tired of it.

1 comment:

Leeann said...

You are absolutely right. It is completely ridiculous and it is WRONG.