Gotta vent: #1 son had to get new orthotics last month, something that is NEVER covered by insurance. But, miraculously, when I called Aetna (yes, that's right: Aetna) I was told that they would be 100% covered. Hear that, Aetna? On May 14th, you told me my son's orthotics would be 100% covered. 100%.
Well, shocker of shockers, the podiatrist's office left a message yesterday saying that Aetna wasn't paying. Really? Did they not say 100% covered? I swear they did.
So I called Aetna this morning, and guess what? They're NOT covered. They would be, if my son were geriatric or diabetic, but since he's only hypotonic, they're not. Somehow, they left that part out. Funny, that.
Amazingly, my 5/14 conversation was documented - they do recognize that they told me we were covered. But we're still really not covered.
I have one, possibly two children on the autistic spectrum. Fortunately for me, my 7 year old is very "high functioning," and fully mainstreamed in the public school. (My youngest is awaiting diagnosis - his evaluation will be in August.)
I'm a working mother who, fortunately, has a working husband and good insurance. Our developmental pediatrician is 100% covered. But here's the thing: She really doesn't do anything except diagnose and recommend treatment. The treatments she recommends are largely therapy-based - behavioral psychologists, social skills, occupational therapy, speech therapy...
None of these treatments tend to be covered by insurance. If you're lucky, you can submit them as "out of network" expenses after you hit a deductible (in our case, I think it's $750) and then you can get 70% back. But my husband works for a big company, so our benefits are great. Most people don't have that much coverage. And not all our therapies will be eligible. Social skills, for example - the therapy we need most - is NEVER covered.
We've used a flexible spending account in the past, too, and even that can't be used for some therapies.
Needless to say, providing therapies for one child on the spectrum is a financial hardship. We haven't even begun to treat child #2 yet.
And again - we're lucky. We're middle-class and well insured. But not all families of autistic children are as fortunate as we are.
So, I was really pleased to see a tweet from MomsRising this morning.
First, I’m pursuing a mandate on insurance companies to ensure they provide affordable, quality treatment for Autism Spectrum Disorders. We must make sure families can get the treatment their children need, through insurance coverage they can afford.
Second, I’m authoring new legislation to provide military families with affordable treatment. My new legislation, the Uniformed Services with Autism Heroes Act or the “USA Heroes Act”, will require TRICARE, the military health insurance program to cover the full cost of autism treatment. Currently, TRICARE caps autism coverage at $3,000 a month – about half the treatment a child needs for effective therapy. What’s worse, thousands of military families are forced to the bottom of long waiting lists for autism specialists each time they are relocated. Families that fight our wars and defend our freedoms should not face bankruptcy for trying to get the medical care their children need.
And as the third step in my plan, I’m calling for a portion of the $10 billion that was given to the NIH under the President’s Economic Recovery plan be dedicated toward autism research to give scientists and laboratories the resources they need to reach the next breakthrough.
Right on, Senator. Now help protect the jobs of women who have to leave work to take their kids to therapy....
Here's the Senator's YouTube video on the topic. (And, btw, seriously impressed by the Senator's use of Social Media.)
I'm a full-time Mom/full-time Web marketer (how many hours are there in a week?) who talks W-A-A-A-Y too much. So I started blogging to give my friends a co-workers a well-deserved break.
