Wednesday, October 29, 2008

Red Tape -- Private Insurance and Medicaid

Yesterday turned out to be another day of nothing... unless meetings and phone calls that use up time and accomplish nothing counts...


We have not always depended on the State Provided Medical coverage to meet our daughters needs. We have private health insurance and gladly use it -- I have already raised two children and never depended on Medicaid for their needs.

In fact, as of the end of September our private medical insurance coverage for Mental Health was used up for the year... By September our little girl had used all 50 of her "therapy" appointments.... Even with Medicaid the "school" and "county" provided therapy bills first the private insurance which pays First then Medicaid picks up the balance.

It wouldn't be such a big deal if the excellent doctor our daughter has seen for more then 4-years only accepted our Private Insurance... Even then we pay for his care under our "Out of Network" coverage and only 50% of his bill is paid. We have had NO Problem paying the $125.00 co-payment every 3 or 4 weeks to see the ONE DOCTOR she has had for the longest time. The ONE Doctor who works closely with me for medication management, and who not only write prescriptions but offers Therapy along with drugs... The One doctor who won't even set a 15 minute medication management appointment because He doesn't do business that way.

The ONE Person who actually is Qualified to Diagnose and Treat her MEDICAL Condition of Alcohol Related Neurodevelopmental Disorder... A Medical NOT Mental Health disorder!

By the End of September all 50 "therapy" appointments have been billed for our daughter... That's 50 by the end of September! The 50 appointments offered under our private insurance works out to be One Appointment Each Week with only 2-weeks in the year off... Our child has had "therapy" much more then once a week!

...I wouldn't care that she had used 50 appointments in 9 months if there had been any kind of improvement at all... Any sign that any of these therapy sessions accomplished anything.

The truth is that our daughters recent Therapist delivered via school (the only school she can attend under her IEP) decided it was a "good" idea to have a "Secret" communication system and encouraged our daughter to write her "Feelings" down and put it in an envelope to sneak to school! The last time my little girl left the house with a sealed envelope it was filled with an inappropriate drawing she wanted to give to a boy...

This therapist still seems to think that everything will be better if our little girl Goes BACK again and wallows in her "FEELINGS" about the things that happened to her before she was 4 years old... That has to be the Root of it all! Doesn't matter that for nearly 6-years our daughter has been having therapy about the first 4 years of her life... Doesn't matter that our daughter has already spent Years going backward... All of her issues must be all about the drama she can hardly even remember! It must be her early abuse her early loss her early this or that...

Over and over not only do her REAL needs go unaddressed but well meaning people want to make it ALL of the issue all of the reason and all of the cause for everything. They believe that continuous Scab-Picking of her Past Hurt will somehow be the Key!

It has been the key--The Key to keeping her Trapped in one spot... One spot that is 6-years ago One Scab she has picked off with every new therapist... One she has no problem picking for them and letting bleed all over. She knows as long as everyone picks that scab there is Nothing about Today to talk about.

Yesterday, the DHSH worker for Voluntary Services made a remark that We Need to have consistency with her Treatment Plan. I completely Agree and always Have which has been the REASON we kept her Primary Doctor--Her Psychiatrist who doesn't take Medicaid and is OUT of our Health Insurance Network... This is why we have driven 20 miles over two rivers to another State for every 3-4 week appointments.

His role is apparently of no value to DHSH since he doesn't Answer to them--since he isn't obligated to work within the Laws of Social Services and since he has no Authority in this state... So to the Worker he isn't Consistent Therapy because the State has no Authority of his opinions or recommendations. The fact we provide her with BETTER then Social Service Provided treatment renders is all as invalid!

...and even considering the fact that Our Consistent work closely with the Same Doctor since 2004 and Payment of the Huge co-payments is not considered valid by the DHSH worker... and even though the "touchy feely" therapy she has been given by the Social Service system has USED Up a year of treatment under an ordinary insurance policy we will continue to See Her Doctor and now we will gladly by 100% of his bill in order to do so.... even though this doesn't count and his recommendations mean nothing because he isn't part of the Social Service System!

2 comments:

  1. Anonymous6:44 PM

    I can follow this, because I live this as well...

    crying for you....

    It make me want to run for the hills myself..

    I hate social services... I think they help no one.

    ReplyDelete
  2. --Sometimes I read what I have written and wonder if it makes any sense to anyone!

    Thanks for the comment I know that there are so many people in the same situation and feel so helpless to even help my child.

    The hills sound nice but, then the morning comes and what do we do? Get up and go another few rounds and hope to find the "magic" words that open a door to anything!

    ReplyDelete

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