These past few weeks have been hard for me. Sad and hard..
I thought I was being proactive. I really thought I was making a great choice. I knew I had 6o combined visits for speech, ot and pt. I want more. Lets be real, 2 visits of speech per week and one OT hardly gets you to the end of the year if you only have 60. I want PT and my 2nd OT visit each week, where does this get me? March>?! I did the work, I had wonderful letters written by our therapists, I gathered all of the reports, I wrote a wonderful letter. The appeal was solid. 31 days after they received my submission they told me they needed more items and only after I called in several times asking for an update. I got everything in immediately. 20 days later after I called in so mannnny times because my representative from hell told me time and again that she would call me for updates or on specific days, only to be out that day or just not call or take my call, I finally got through. She had an answer back from the RN which I had learned from a customer service supervisor who finally took my 999th call. She said I have an answer, it's on my desk, but I can't read it, it's illegible. SHE TOOK 20 DAYS COULD SHE MAYBE HAVE TYPED IT OUT FOR HER?? It took 5 additional days to get the answer and when she did get it, she barely understood it enough to explain it to me. They re-requested RX's that I had provided just weeks before and then wanted a letter from my therapists or Dr. saying that since my visits are not exhausted yet, how do we know he will need more therapy. I said how do I know that my son who does not speak, won't speak the language fluently in 3 weeks time????? Just a flipping guess~!!!!!! I had the letter written and forwarded it on. I called in a bunch more times to see how it went. I knew it was going to the Medical Doctor specializing in speech. That made me happy, someone with a brain and a direct knowledge... I now know that said medical board that I originally pictured as a sophisticated group of professionals was simply a bunch of chimpanzees throwing fruit and paper around. This was a mind fu*k and a gut fu*k. The whole process was disgusting, my rep was disgusting her behavior and lack of communication and service but most of all what she said to me the one time she finally called.
I was waiting in the doctor's office for our appointment and she called and said, not only are we denying your appeal, but we are going to review every claim we have payed so far because your son is under the age of 6.WTF!!!! I told her how archaic that was and who in the world waits until 6?! child neglect anyone? She said a rep who works with my husbands office would contact me.. I said I'm not worried, I 'll go to court forever , we had pre-approval and our policy does not have an age description written in the verbiage. I had to go because we were called in for our appointment but when I tried to call later to find out exactly why we were denied, she wouldn't take the call saying that she was done with the case. I want to fax a blank page with only the word KARMA written on it because Karma is a bitch and I fear for her... If ever a Karma-gram was called for. Maybe I'll send her a pack of Karma-grams. I still haven't received a call from the rep or the letter stating our denial. It's clear to me and many others that she is mad at me and so this is her effort after the choice words I used on the day that I lost my cool. Nice of the other reps to share my words with her.. In hindsight I'm glad they did.
I decided though that our life is no longer on hold because of them . I set up our pt eval and she said that he is functioning at an 18 month level. Not awful but not great. I think she said it well when she said that no one has suggested pt to us because the other challanges are so much more in your face. I have set up a 2nd ot every other week on the opposite week of our every other pt. I found this amazing play tutor from a friend who met my son for 2.5 minutes but relayed a message through my sister who knows not much about all of this (*yuck) saying she knows this great gal. I didn't love that she knew after seeing him for so little time but like my dad so bluntly said ;) she has a ton of kids and if you don't think people can see it get with the program. ouch! He is very supportive and generally a bit more couth. Now that the burn has subsided, I think it was good to hear it even though I'm sure if I hadn't caught him in a stressful moment at the office, he woulld have said it much differently. The play tutor was WONDERFUL, I hired her twice a week. Packing it in this summer since there are zero camps in this town for anyone under 3. With my spare time some day in 20 yrs, maybe I'll start a camp for special needs under 3. speech at least! Not sure where the money is coming from for all of this and not sure what will be with insurance since M's HR rep has been working on it for us for going on 2 weeks and still can't get a call back, ( LOVE INSURACE CO'S) but if I have to work or cutback so be it. I 'm not letting them decide how well my son does. We got his schedule for early on school program next year and I can't wait until he starts! I've heard wonderful things.
He is sick yet again, basically 2 mos straight. Up all night last night. I'm ready for a new beginning and whoever is effing with my kid to leave him the eff alone!! I feel more together now and ready to deal. The broken collar bone, inhaler etc etc etc etc. It's hard enough having a kid with delays so I'm sick of the extras but I'm ready to take them all on now. Be even more ready after I sleep!
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