Dealing with Medical Insurance

Before I go into any details I want to let everybody know that we are VERY lucky in that Brycen qualified for waiver services and Medicaid insurance shortly after he received his official dx from U of I! Shortly after Brycen qualified for the Intellectual Disabilities Waiver which includes the Medicaid, respite and SCL services, this waiver was full and now others are on a waiting list. The other three waivers that are available depending on the child's dx are also on waiting lists which is not fair to those parents that are battling to get insurance to cover necessary appointments, testing, and therapies. One 1/2 hr speech appt is billed at $77! Can you imagine trying to afford to pay for those appts out of your pocket...much less usually 4-5 appts a week are needed?!

So how our insurance works is that every dr appt and therapy appt are run through our private insurance (Blue Cross Blue Shield) first and then Medicaid will pick up the amount that is left. We were initially told by the therapist and a doctor at U of I that BCBS would not cover any of his therapies, which is what made getting Medicaid so important to us. With Autism, studies have shown the earlier a child receives consistent intervention, the decrease in services they will need later in life and during school. Why the heck would insurances NOT cover this then? This has been a hot subject in various state's governments lately.

Anyway, surprisingly to us...Brycen's speech for May WAS COVERED by BCBS! I'm not sure of all the details, but my understanding is that prior authorization is needed and since Brycen's doctor gave an order for the therapy and because his records and treatment plan demonstrate that he is not talking and far behind other children his age, this was the reason it is covered. The extent of coverage is not known at this time, but we are guessing about 20 appts each calendar year which we know Brycen will have burned through in two months, but Medicaid will pick up the rest of the speech appts which is AWESOME and they currently pay the 10% coinsurance for each of the first 20! The OT is the same way in that they will cover 20 appts each year and since he started later with OT and only goes twice a week, very little will need to be paid by Medicaid for this year.

We are some of the lucky ones and compared to some other states, Iowa is far better with more waiver spots and also other ways of getting Medicaid before a waiver spot if income is low enough. Of course, Iowa is not the best state...but I have been told that moving to MN would really decrease the amount of services we would get and we would be placed back on a waiting list. That is not acceptable as we definitely can't afford to pay out of pocket for the therapies he needs without going far into debt...what hard-working family could? The reason I need to work is to pay just the bills we have now and the groceries and diapers we need now...there is not extra money to pay for that cost, much less I couldn't work more hours to help with that since I would need to be available to take him to all the therapies and appts. I really feel bad for those families that are battling this right now in Iowa, all other states, and across the world that aren't qualifying for insurance that will cover what is needed for their child. As if these parents of children with autism and all other life-long disabilities don't have enough to handle!