Big Fight For a Little Tyke

A seemingly inconsequential thin white card residing in the first slot of my wallet can mean the difference between life and death. Carrying the weight of an entire family on its flimsy laminated surface proved too much for the little paper. After a slew of abrasive phone calls and the daunting task of deciphering legal documents, resembling a dissertation on Greek phonetics, we were able to produce a secondary Medicaid card.

We all know about the primary insurance industry and the struggles of the elderly and unemployed, but what about people who embrace false security? People like you and me. Being previously employed by a rehab facility, I have witnessed the unimaginable discharge of a new paraplegic who can’t complete a transfer independently. Insurance dictated thirty days and no more for rehab, even if that means the patient will return with bedsores or pneumonia in a couple of months. The insurance company obviously did not comprehend the astronomical amount of money they would save by completing a treatment plan in order to avoid complications.

One might think my experience as a rehab therapist would prepare me for my own insurance battle, but I was in shock when my son’s therapy bills started pouring in. The insurance company stated that developmental delays are not a medical issue. Months passed during the debate, wasting precious early intervention time for my child. With the verdict decided and appeals exhausted, the only choice left was to pursue another route of coverage. The illustrious Deeming Waiver was the answer to our prayers. So we thought.

In order to receive the Deeming Waiver from Medicaid you have to stand on your head while drinking water and whistling. The only way to insure an approval is to spend a thousand dollars on a private sector specialist to complete the paperwork.

We completed the application process via the expensive private sector specialist and anxiously awaited the results. After several months we finally received the all important acceptance letter. To our dismay it was back dated four months. Knowing we only had eight months left of funding we quickly dove into therapy. For one month my son received everything we had hoped for, but for Christmas the primary insurance company sent us a big red ribbon gift of coverage. The gift turned out to be coal fueling the fire for another battle. Now that the primary insurance company made the announcement of coverage, Medicaid quickly refused to pay. With no local therapists in network the therapy was placed on hold again, as the two thin white cards rested in their safe top slot of my wallet for several more months.

Only through diligence did I finally find a therapist that was covered by our primary insurance company. It might be inferior care in a less than desired location, but it is better than nothing. That is what a thousand dollars and a year of fighting got us…something. The good news is that our government is starting to hear our plight. In several states it is now mandatory for insurance companies to cover developmental delays until the age of six. With one in a hundred and fifty children nationwide being diagnosed with Autistic Spectrum disorder, something has to change. If we do not insist on change now, the insurance companies are going to be the ones requiring a bailout program in the future. A little money out of their pocket now can change the future for a special needs child to become an independent adult, saving tax payers money in the future.