9.13.2010

interpretations

I have never been good at seeing shades of gray. 



I suppose I was just Wired to see things as black or white.  Right or wrong.  



So when Blue Cross Blue Shield of Rhode Island informed me (via my new case manager) to take my outpatient Speech Therapy cause up with the State Legislation.  As the Law is clear these therapies are to be provided by the schools for peoples between the ages of 3 - 26.  There may have been steam thundering from my ears.  I really couldn't say.  I was too busy fuming.  The fire was further stoked when I was asked if Trevy has Medicaid.  Because, after all, isn't that what Medicaid is there for? 



Why now that that you ask....



NOOOOOO  



I suppose I'm old fashioned or closed minded or whatever...but I'm rather convinced that's what my Health Insurance is there for!  



Because frankly... 



...if Trevor doesn't fit the bill of who qualifies to have insurance covered Speech Therapy in a hospital clinic (because it's needed in addition to what the school provides!) then why have the freaking service listed as "covered"?! 
The going broke State should not have to pick up the tab for the insurance provider. 



And furthermore, please pass on to your manager...



I calmly responded to the young lady on the other end of the line...



I'm up for a round with the Legislators and I hope he is too.  Because while Medicaid may indeed cover this extraordinarily necessary therapy...it does not mean that I will not appeal Blue Cross's decision to the highest levels.   



She passed my message on to him early last week.  



Evidently he isn't up for a battle after all.  I took a call late Friday afternoon from our case manage (who is a very sweet young lady actually). She could hardly contain her enthusiasm while informing me that the decision had been reversed!  Her advocacy...that of another nurse on staff whose family has been touched by autism...and perhaps my steaming...all worked together to reverse the decision!   



Turns out there's wiggle room in how one chooses to interpret the RI State Law as it applies to little boys who've endured radical brain surgery.  



Which works out well for me actually.  As my hands are plenty full without battling insurance coverage! 

7 comments:

blogzilly said...

I wonder if this is why we seem to have drifted apart somewhat? Because I am just one big shade of gray...no black or white in me whatsoever.

Your Health Insurance sounds like it sucks. Does RI offer any kind of Medicaid Waiver? We have Bennett on that. It is not dependent on income relative to the parents at all. It is only relative to the child and their medical situation/income. I may have asked you before, but it essentially kicks in on anything our asshole insurance won't cover.

JSmith5780 said...

Sp proud of you for sticking to your guns and getting Trevy what he deserves!

happy's mommy said...

@Kenly...no drifting just busy. SO busy. TOO busy! Also...I've never really taken you as a gray guy.

Trevy does have Medicaid. But it galls the crap outta me that our primary insurance would try to pass the buck. It's wrong. Not gray! And I was willing to fight them tooth and nail on it. Happy that it turns out I don't need to. But I was ready to. I felt that deeply that it was wrong for them to deny him that coverage. Especially since that is the ONLY out patient therapy I'm asking for!

@Jenny...thanks!

...danielle

Anonymous said...

Yes, it is wrong. Plus, the medicaid providers are already overwhelmed and they have endless waiting lists. You have more providers to choose from with commercial insurance and that frees up the medicaid providers for people who only have medicaid.

Glad to hear the fight wasn't too difficult. Did they tell you how long before you have to fight again? You may have to go through this every 10 or 20 sessions to get it reauthorized. More fun for your already full plate:-)

Erin

TherExtras said...

I am very pleased the potential battle went up in smoke. (Hope you've been reading at my place in case the next time requires more heat.) Barbara

happy's mommy said...

Erin...I forgot to add that part! We're approved for one session weekly for the next YEAR! I could have asked for more sessions too. But trying to balance the needs of three kids...one is all I can handle. And with Trevy getting such wonderful ST in school...I think once a week is right.

Barbara...I've been SO crazy busy...but yours is on my list of MUST read by this weekend!

...danielle

TherExtras said...

No pressure, but came back to mention that I had 3 posts on Medicaid recently - but I think you did comment on one. So never mind....;)