Tuesday, September 30, 2014

Missing ABA therapy

Now that Andy has been in school for almost four weeks, I am missing all the good things the ABA
therapists were working on with Andy. I visited Andy's classroom, and got to see him going to music class. I also got to see him in circle time and snack time. The classroom, and going to specials like music and art, seem so good for Andy. The experiences seem very enriching for him. But I also miss his ABA therapists.

They were so good at what they did. They analyzed his behaviors and worked hard on how to change them for the better. They were starting to understand Andy, and beginning to really shape him. I took him out of ABA therapy for two reasons. My insurance company was rejecting all claims, which was scary, and school was starting.

I was told I needed to leave Andy in all-or-nothing ABA therapy. They wouldn't agree to 12-15 hours a week. I was told it wouldn't be enough to make a difference for him, and that he needed the full 25 hours a week. This therapy is very costly, and our current Blue Cross Blue Shield plan is rejecting all ABA therapy claims. They say we have no Autism benefit and they do not fall under the mandate to pay for Autism claims. We are searching for a new policy now.

I wanted Andy to start school and see his classmates again. I wanted him to see his therapists, and have the benefits of gym class, music class and art class. All the different experiences seem to be so exciting for him. When I went to observe him for a couple hours, I did see him crying quite a bit, but I also saw him having great experiences too.

If we can get an insurance policy that has an Autism benefit, I'd like him to receive ABA therapy, and go to school maybe 2-3 days a week. I think this would be a good balance for him. The next step will be finding a place that will agree to do this. If he has to have 25 hours a week, this will leave no time for school activities.

The ABA therapists were making such good progress with Andy. At his school, I'm not sure how much progress they will make in him. It is hard to tell right now, if I am making a mistake by valuing the school program so much. His doctor told me that is a big mistake to take him out of ABA therapy, but that she doesn't want us to go bankrupt trying to pay for it.

All we can do is try to secure a new policy and continue to move forward. I'm hoping that soon we will find Andy the balance he needs to progress. This is a tough choice.

Friday, September 12, 2014

Andy is still pointing to communicate

Andy has been pointing to communicate with me when it is time to eat. I set down his water cup, a salad, and his dinner plate. He will point to the item he wants, when it is time for him to take his next bite. He has been doing this consistently for a week now. It is so awesome to feel like he is understanding what I am asking him, and that we are communicating. I know that the summer in ABA therapy has helped this along, and I am very grateful. I've tried to catch it on video, but Andy gets camera shy.

Andy's first day of Kindergarten with his big sister

Andy swinging on Labor Day

Andy getting sleepy on his piano

Blue Cross Blue Shield is rejecting my son's Autism claims for ABA therapy

This is so awesome! Blue Cross Blue Shield of Michigan has decided to reject all of my son's Applied Behavioral Analysis claims for Autism therapy. I spoke with one of their representatives before he got any therapy done. I noted the time, date and duration of the call. I gave the rep each CPT code that the Autism Center would be using. I was told each would be covered at 90 percent, and using the Autism diagnosis code of 299.00 was fine.

When the center called BCBS of MI they asked if an authorization was required before going ahead with therapy. They were told "no auth is required, just start billing". So, based on my call to them, and their call, we started therapy. The center didn't bill until about a month out. I checked to see if there were any pending claims, every week. I finally could see some, when he was already at week 6.

How much does ABA therapy cost? This is what I kept asking the center. They would tell me, it's different for everyone, and did not want to give me a dollar amount. Well, ABA therapy costs around $1,000-$1800 a week. Yes, a week. They billed per fifteen minute units, and it is pricey. My son was there for 5 hours a day, 5 days a week.

It did benefit him, as he is pointing to what he wants now. I offer him two choices of what to eat, and he points to what he wants for each bite. ABA therapy has helped him to communicate with me. He was worked with one-on-one for the whole day, and now he is starting to show signs that he did learn some communication skills from them.

It is a bummer that Blue Cross Blue Shield is doing this to us. We have a PPO plan. It is super expensive too. They usually cover everything. A rep called me and told me, "although the president passed something to make insurance companies pay for Autism claims, we don't fall under the state mandate". So, my son's claims have been rightfully rejected.

It is coming down to them finding the recording of me talking to the representative on the phone. They are supposed to listen to it, and see what she told me. Hopefully, they will realize they should pay. We wouldn't have gone through with the therapy had we known they wouldn't pay.