Fragile X Friday - Great News "Not"

So I wanted to give you an update on our services and the ongoing struggle to maintain them.

So upon writing this blog post I still don't have a review date scheduled, but I am hoping to get one soon. My current plan is to not include our speech therapist in the review, the case manager hasn't asked her for a report, so I am going to assume she is not to write one, and our services with her will continue based on the current authorization through October 31st.

So my current focus is on keeping our IDS (Infant Development Specialist) and my PT (Physical Therapist). They will be at the review sometime around Holly's 18 month birthday which is September 11th. Our case manager asked them both for their reports early. Our PT rushed to get hers in, but the IDS had only just started and wanted to make sure she was thorough and diligent. So she told her it would take a few weeks.

The PT Sally emailed hers in and we got a response from the case manager pretty quickly:

"I got Holly’s chart back from revision and I believe she is good to go in
the Early start program. I believe what will happen is they will switch her
eligibility from High risk factors to Developmental delays, due to her delays in
gross motor, so that will keep in her in the Early Start program."

Great News!! - Right... You would think this is great news, our diligence has paid off and we get to keep our PT and everything will turn out just fine.. What ever was I worried about.. But then I continued reading further...

"However please keep in mind that effective 8/25/09, families are required
to use their private insurance for services. Regional center of the east bay is
“payor of last resort” so they are now requiring this."

WHAT! Seriously... is she kidding! What is the point of doing all of that work and having all of that worry to get her qualified and approved to continue early intervention services just to have them tell us, sorry you have to have your insurance pay for services?

Well my insurance certainly doesn't cover in home Physical Therapy, and with a HMO, they certainly won't cover the provider of my choice, so even if Sally is willing to work for private allowing me to get reimbursed, my insurance doesn't do that. So if I have to go that route, I loose Sally.

I was advised to find out what my insurance does cover and let them know. So I did. I was told that we get Physical Therapy (if we have prior authorization from the medical group) for up to 60 consecutive days per injury.

Well Holly doesn't have an injury, so what does that mean. And if we did somehow get authorization for a PT it would not be in the home we would get the PT who is at the Hospital, there is only one PT there and she works like only 1 day a week. So if somehow this were to become our new "PT" I would have to drive Holly to an outside location that she is unfamiliar with at a time that is not convenient for us, and hope that she gets something out of her session, with a new person whom which she isn't bonded to. It took her months to get used to Sally, I can't imagine her getting someone new.

But from what the insurance company said, it seems that since she doesn't have an injury she isn't likely to get coverage without a "fight" and since I would rather her continue with our existing services, and no where does it say I have to fight the insurance company for coverage, I am not going to push it, and we will see what happens next.

Sally says they will need a letter of denied service, I would rather not have to jump through all of those hoops, this entire thing is so infuriating! We will see what the case manager says when she gets my email, and I will update as things develop...

I don't even want to think about it, but the same goes for Speech.