Insurance plans, we have a few…

Jerah was originally covered by his dad’s insurance primary, then Medicaid, secondary. Then we started having behavioral issues at the end of last year, and I was worried that Jerah would need more insurance coverage because I received a letter in the mail telling me that his Medicaid benefits were being ended because I make too much money. I do not make a lot of money, folks… but according to the government, apparently I am well-to-do, wearing pearls and high heels around my mansion, drinking tea with my pinky finger pointed up towards my chandeliered ceilings.

I make the brilliant decision to add Jerah to my insurance plan at work, Blue Care Network. I should have checked into the Medicaid thing, because, turns out, he was still covered by Medicaid. But because I added him to my insurance, I have to continue carrying insurance on him for as long as I have this job, because if I go and cancel him off my plan, Medicaid WILL go away.

Jerah spent all of March, April, May and June in a state psychiatric facility. He went in on the last day of February and returned home on the last day of June. He was not supposed to come home without in-home ABA services set up… but of course, my insurance is RIDICULOUS. They require that Jerah be diagnosed with autism. BY AN “APPROVED AUTISM EVALUATION CENTER.”

Let me just say, I have been working for the last few years at cleaning up my vocabulary. I used to cuss like a sailor… and I was doing so good… but THIS insurance insanity…. #@%&!!! Oh it makes me want to swear and it makes me want to swear AT PEOPLE… particularly insurance people. But I know that the monotone, emotionless people I speak to at the 800 customer service numbers at BCN are not the people making the decisions and setting policies. So I would end up feeling terrible if I went off on one of them. They don’t deserve my anger. They probably hear it from multiple angry people every day. I do not envy them or their jobs. I do wonder if they have good insurance benefits… I wonder if their mansions are bigger than mine… but I digress…

Anyhow, Jerah, who was diagnosed at 3 years old with autism by the Calhoun County Intermediate School District (a team of a Speech Language Pathologist, an Occupational Therapist, a Physical Therapist, a nurse and a special education teacher or school social worker descended upon my humble abode and spent a couple hours observing Jerah and interviewing his immediate family members). He was then diagnosed with autism again by his pediatrician. Then when we applied for disability, the federal government sent us to a psychiatrist who watched Jerah (spinning in the office chair looking through his wriggling fingers at the fan above him) for all of two minutes and said something to the effect of “Yeah, I don’t know why they sent you to me, he definitely has autism.” He has been in a special needs autism based school class every year since he was three… and he spent four months at Hawthorn Center, a state psychiatric facility, under the care of two psychiatrists, a medical doctor, a team of nurses, behavioral therapists, and social workers… and they ALL 100% agree that his diagnosis is autism, and only autism. But, NO, those diagnoses do not count! BLUE CARE NETWORK NEEDS SOMEONE ELSE TO DIAGNOSE HIM. *facepalm

They ask me “Has he been diagnosed by an AAEC?”

My brain: “No, probably not, what the #@$% is an AAEC?”

My voice: “I don’t know what an AAEC is…”

BCN: “An Approved Autism Evaluation Center…”

My voice: “No, probably not. You wanna know why? Because you people had not thought of an ‘Approved Autism Evaluation Center’ ELEVEN YEARS AGO WHEN HE WAS DIAGNOSED WITH AUTISM.”

So, I call multiple Approved Autism Evaluation Centers, because of course, you just have to bend over and let the insurance company tell you what they will pay for and how much they will pay for it and just how many hoops they need you to jump through in order to pay for it… (why am I giving them my hard earned money again?) (sorry, I may have ADHD, but I would need an Approved ADHD Evaluation Center to officially diagnose that… *rolling my eyes)

Guess what… these AAEC’s are either not answering phones at all, or have some poor call center gal answering calls, just to tell people that because of COVID-19 they aren’t currently open. I finally find one that will put me on their NINE TO TWELVE MONTH WAIT LIST for an appointment to have my autistic son diagnosed with autism. My brain hurts.

Okay, so, let me get this straight, Jerah was supposed to have behavioral therapy in home set up BEFORE he left the psych hospital so that it would start within 2-3 days of his release… and now, a week after his release, we are going to be put on a year long wait list to get a diagnosis we already have so we can get in home support that we needed a week ago… my brain REALLY hurts.

It gets better… and by better, I mean worse. I ask the place for a letter stating that Jerah is on this wait list, because if I have that, apparently we can get what they in the insurance biz call “gap authorization” and we can start in home services right away. Two days goes by and I get an email from the AAEC stating that they have not put us on the wait list because the insurance companies are not in agreement as to who should be primary and I have to figure that out and let them know.

I spend an hour and a half on the phone this morning. BCN is not my friend. I do not like them, Sam I Am. If they were on fire and I had the only glass of water left on the planet, I would drink it and watch them turn into a pile of black soot.

BCN says they will figure it out and let me know via mail “in about a week.”

I call Cofinity, Dad’s insurance, and they tell me it goes by whoever’s birth month comes first… which is Dad’s… but she had assumed that we shared custody. We don’t share custody, my dude is all mine.

Cofinity was nice. I like Cofinity. They are my friend. I do like them, Sam I Am. If they were on fire and I had the only glass of water left on the planet, I would definitely pour it on them and go in search of a fire extinguisher.

Cofinity explained that custodial parent’s insurance is primary. Then non-custodial parent. Then Medicaid. Great. Thank you, Cofinity. I told the call center lady that she was awesome and I loved her, and that I did not like BCN. She found me funny. Told me to have a great weekend. I pray God pours blessings on her so big that her cup overflows and she has to share the blessings with her friends and family. I will pray the same for the BCN lady too because we are supposed to pray for our enemies. ;o)

Now we wait for the AAEC to send us The Letter, so that we can get the Gap Authorization, so that we can get the in home therapy that should have started over a week ago.

Welcome to Insurance Policies and Autism. (O.o)

Published by justjerah

I am Mom to Jerah (a super cool 14 year old diagnosed with autism), a social worker on the side, a recovered drug addict established 4/15/2014, and a highly creative person who needed another artistic outlet, so welcome to our blog.

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