Monday, March 16, 2009

Friday Funny, more swimming and the battle of insurance

So Friday night, we had arranged a babysitter as Rod had a certification to go to and I had class. the babysitter cancelled adn we ended up taking Dominic to gramma's house. He's never been there without us in the evening before. So i fed him at home, gave him his bath, put on his pj's and handed him his jacket, which he took off. I put him in the car. He was MAD. Routine does not include a car trip after bath you see.... so he fell asleep on the way over there, and was so upset to find himelf at gramma's in his pajamas that he took them off. Entirely. So i left as he was running around butt naked screaming mad and she was trying to put his clothes back on. He was just upset at the change of routing. If we'd left the bath for after he came home, it would've been fine.

He's doing AWESOME swimming. I took him friday morning and then again this evening - on Friday we were by ourselves and i had him floating on his back, completely unassisted for counts of 10-15. He can totally do it, but he tends to panic if he thinks he's doing it alone. Tonight Karen was there, and he was super clingy, but by the end of our time, we had him floating with a pool noodle under his back, and he wasn't clinging to it, or death gripping, but literally just floppedn over it. WAy cool.

So i've got an HR rep within my company whose sole existence is to work with the insurance compnay and help employees with whats going on. I've been working with her for several months now. Here's the thing - my insurance company does not cover anything related to a diagnosis of Autism (good thing I made the neurologist give us a diagnosis of Aphasia...), and they don't formally pay for ABA therapy. BUT, the billing codes that Alphine Autism Center uses for Tricare are in our ins's system and they DO NOT send a flag out for clarifation or denial. Which is fascinating. So I've got her going back to her contact at the insurance and having him dig deeper to find out if it would flag their system to get a bill for 60 hours of these codes in a month. So it appears that there is a very slight chance that we could bill them with a diagnostic code of aphasia, and use these billing codes and they would pay out of network. Which is 70%. That would make this MUCH more affordable for us. The only issue would be if the fact that the bill would say Alpine Autism Center on it flagged them. No idea on this one...

Even if insurance won't help, we've got money put aside for 3 months of Alpine, at half days, and we're going to start that the last week of May. I've talked with them and they're willing to let us commit to just 3 months because they've got a child who is leaving. I'm hoping that the dates match up, that would be ideal.

The other iron in the fire I have going is that I've formally asked my HR department to change the coverage of an autism diagnosis - they didn't cover it at all in 2008, and in 2009 cover to age 3 (which is STUPID as most doc's won't diagnose prior to age 3),and they're going to revisit the whole topic for 2010. Doesn't hurt that i provided documentation showing that all the states in the country either mandate coverage or have legislation in the works to mandate it. Even tho as a self funded insurance policy thye don't HAVE to go along w/state mandates, they would if it were federal. And they still may. They just probably havne't had anyone complain before - most people would just see it wasn't covered and go away.

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