Tuesday, August 06, 2013


I have been wanting to do this Just Write thing for a while and Im going to try it tonight.  The one thing you should know about me is that the damned apostrophe on my keyboard is broken, some KID broke it, and I am MAD but the thought of taking it in to the Apple store makes me want to cry so for now, no apostrophes.

  • Anthony had a great day today at school.  He had no accidents in the morning, or the afternoon, he wore his braces for most of the day.  We came home and got changed and he TRIED to poop on the floor but I caught him and he went on the potty instead.  So, um, win?  I guess?  Then we went to OT and he was upset at first, but she calmed him down by rolling a ball on him as he lay down on the floor.  She had to put a lot pressure on his back but he loved it and calmed right down and could focus on what theyre working on, which is scanning and choosing the right object from a group of two or three objects.  
  • BUT his program manager called me today and said that the Clinical Director, I think thats his title, wanted to meet with both of us, both me and Mike, and when would be a good time for us to both come in.  Um, never?  I said that Mike would be there tomorrow to drop off Anthony and he could just meet with him then.  She asked wasnt there any way that we could both go?  I said maybe you better tell me what this is about.  I thought maybe they were kicking him out or something.  But she said they were just wanted to share with us some information about how Anthonys insurance company, um, didnt want to pay for 40 hours more a week of Anthonys ABA therapy.  
  • VERY annoying.  Even though we take him to see his developmental pediatrician TWICE a year to say that he STILL has autism, even though he does in fact, still have autism, and have it kind of BAD, it doesnt matter.  The INSURANCE COMPANY has decided that they no longer want to PAY for Anthony to get the therapy that he is PRESCRIBED by a DOCTOR.  I asked his program manager, what of the prescription that his doctor has given?  She said the insurance company has a GROUP of EXPERTS, although not MEDICAL DOCTORS, and they would decide.  The thing is, they decide for EVERYONE that what they dont need is FORTY HOURS a week of ABA therapy.  Isnt that a coincidence?  
  • They want him to transition to the free and public education that is made available to him.  Every time we have met with that school system, they have NEVER indicated that he could go to school twenty hours a week.  I had to fight like a NINJA to get him to go to Kindergarten in the morning one time a week, remember?  But thats what we are supposed to do.  We are supposed to start the transition for Anthony to go to school 20 hours a week and go to Little Star 20 hours a week.  How is that supposed to happen?  Is he just going to go into the third grade?  What about the bathroom?  The bus?  Are all the doors locked or will he have a one on one person to help him not bolt out of the door and into the street?  
  • My guess is that there arent any answers for this.  We are going to have to go to a million meetings and then what we will end up with is something that is good for exactly NO ONE except the insurance company. We can just keep paying Anthem hundreds of dollars a month and they can just ignore the autism mandate and ignore what Anthony needs and we are just supposed to do what they say.  
  • I dont even know.  And you know what else?  Why are we meeting with the RESEARCH AND TRAINING DIRECTOR?  Why is he the one with whom we are discussing insurance?
  • Why arent they sticking up for us, for Anthony, more?  Im afraid its because we dont pay enough.  I cant even think about it too much.  I have been post phone call for like 9 hours and I am going crazy.  
  • So I guess Mike will go to the meeting and find out whats what and we will appeal and whatever else.  We have two months that he can go full time.  TWO MONTHS.  I feel like all of this happens with no notice to us.  We get letters over holiday weekends, now we have two months to figure this out.  
  • I cant believe this is supposed to be better for us, for our country.  We have insurance - we have insurance as a family, for which we PAY and we have insurance for Anthony, for which we pay, too.  What the hell?  
  • Anyway, just like everything else, Im going to pray on it.  I pray that we will not be abandoned but, and this is not for the first time, but its the first time in a while, I feel like its not going to work.  I feel like we are all alone.  

1 comment:

Doing My Best said...

Oh, this is awful =(! I hate that insurance is SO MESSED UP!