We got a nice surprise in the mail today. Our son's individual Blue Cross Blue Shield of Michigan insurance policy has authorized ABA treatment for Andy. The letter they sent also states that the notification we received does not guarantee payment for services. However, they are authorized. It is a little confusing.
They are allowing 600 units of Therapeutic Behavioral Services, with a unit being 15 minutes. It looks like the authorization is only good through March 31st, which doesn't give him much time to get started back into the program. I don't even know if they have trained staff for him yet. Hopefully, the center will be in touch with us soon, and can get these dates extended. They are also authorizing home care training, and training to the home care client, which would be me.
The authorization was done by an outside company called Magellan Behavioral of Michigan. The procedure codes authorized were: H0031, H2019, S5108, D5111, and H0032. These codes were denied by my son's previous Blue Cross policy, because we supposedly didn't have autism coverage on that policy. However, when I called the previous insurance company's policy reps and gave them the above codes, I was told they'd be covered at 90 percent. Then they rejected all the claims.
His new individual policy has Autism coverage, and falls under the state mandate on Autism coverage. Apparently, 80 percent of employer given insurance policies do not fall under the Autism mandate. So, we sought out an individual plan, and asked specifically about the Autism coverage before signing Andy up for it. What a hurdle this has been.
Saturday, February 28, 2015
Tuesday, February 24, 2015
Revisiting private PT again
We are headed in the direction of Andy receiving private Physical Therapy again, in addition to school physical therapy. He will be seeing a therapist that he is already familiar with at U of M rehab. I talk with the school PT on occasion, but sometimes it is nice to have additional opinions too. Plus, if he needs to have therapy over the summer, then we will be better able to have it for him.
I just picked up Andy's new Ankle Foot Orthotics (AFOs). He has boots that are two sizes bigger to go over them. Andy's stance is already becoming stronger, so I'm excited to see how much better he will do with the new braces on. They go up to just below his knee. They are supposed to help support his legs and put his feet into the correct position.
Andy currently takes about 200 steps a day, with my help. I hold him at the shoulders and stand behind him. He is not steady enough for me to stand in front of him, or hold his hands. He would have to be able to hold the stance on his own, in order to do that. I don't think it will be very long now until we will see him being able to stand for a few seconds on his own.
Andy does not pull to stand up, or get on all fours, but I know this will come later. He will start to learn this I think as he gets more motivated to get up on his own. It is just what I think after observing him for five years. He has to be motivated on his own, to build the confidence to try new things.
I just picked up Andy's new Ankle Foot Orthotics (AFOs). He has boots that are two sizes bigger to go over them. Andy's stance is already becoming stronger, so I'm excited to see how much better he will do with the new braces on. They go up to just below his knee. They are supposed to help support his legs and put his feet into the correct position.
Andy currently takes about 200 steps a day, with my help. I hold him at the shoulders and stand behind him. He is not steady enough for me to stand in front of him, or hold his hands. He would have to be able to hold the stance on his own, in order to do that. I don't think it will be very long now until we will see him being able to stand for a few seconds on his own.
Andy does not pull to stand up, or get on all fours, but I know this will come later. He will start to learn this I think as he gets more motivated to get up on his own. It is just what I think after observing him for five years. He has to be motivated on his own, to build the confidence to try new things.
Monday, February 23, 2015
Sunday, February 22, 2015
Moving Along
Andy and I are moving along nicely. We are having very happy and pleasant exchanges with each other, and our bond is stronger than ever. I can tell that he loves me so much. It might be due to him being on his feet a lot more. It is supposed to be very good for the brain.
He has been taking assisted steps now, every day, for months. Every little bit is building up to small amounts of developmental gain. We are both very happy. His crying is down to a minimum. He shows love for me all the time with big smiles, and cuddles. He enjoys school, and I am working on finding some ABA therapy for him again.
The family as a whole seems much happier. I feel I can focus on other things, and that our world doesn't revolve around Andy. He is a part of it, but not all of it, all the time. Things are balancing out a little better and it's been great! Despite the absolutely frigid temperatures we have here, we are all feeling much better lately.
He has been taking assisted steps now, every day, for months. Every little bit is building up to small amounts of developmental gain. We are both very happy. His crying is down to a minimum. He shows love for me all the time with big smiles, and cuddles. He enjoys school, and I am working on finding some ABA therapy for him again.
The family as a whole seems much happier. I feel I can focus on other things, and that our world doesn't revolve around Andy. He is a part of it, but not all of it, all the time. Things are balancing out a little better and it's been great! Despite the absolutely frigid temperatures we have here, we are all feeling much better lately.
Saturday, February 14, 2015
Need to get back to ABA therapy
It is clear that Andy needs to be back in ABA therapy. They work one-on-one with him on his exact needs. I am learning from my county services offices that ABA therapists don't typically go into the schools. They advised that I contact the special needs director for my son's school district, to ask about having ABA put into his IEP. However, they are doubtful that this will happen. They said I would most likely have to split his day between school and private or home ABA therapy.
The problem is that the last center I had Andy in did not like that option. They wanted him full time at therapy, which we could not afford. Our insurance company would not pay his claims either. Now we have purchased a new insurance policy for him that will hopefully cover ABA. For now, I might just have to settle for Andy being in ABA therapy for the summer, and he would be lucky to get that.
The current school program that he is in is teaching things like writing letters, and days of the week. Andy isn't developmentally at the stage to learn these things. He doesn't communicate a whole lot to anyone, and is still immobile, unable to self-feed, and like a 6-8 month old.
His school provides structure to his day, and gets him out of the house, but I don't know what he is taking away from it. Many professionals have told me his only chance at advancing is through one-on-one ABA therapy. I think I believe it to be true now. I'm not seeing Andy progress anywhere as of now. Whereas before with ABA therapy, he progressed a small amount, which is better than nothing.
I am very stressed with all of this new red tape to deal with and going back into unknown territory. The super cold 0 degree weather is also very non-motivating and makes me so tired. I continue to try and set small goals for the week, so that I can feel like I am accomplishing something.
The problem is that the last center I had Andy in did not like that option. They wanted him full time at therapy, which we could not afford. Our insurance company would not pay his claims either. Now we have purchased a new insurance policy for him that will hopefully cover ABA. For now, I might just have to settle for Andy being in ABA therapy for the summer, and he would be lucky to get that.
The current school program that he is in is teaching things like writing letters, and days of the week. Andy isn't developmentally at the stage to learn these things. He doesn't communicate a whole lot to anyone, and is still immobile, unable to self-feed, and like a 6-8 month old.
His school provides structure to his day, and gets him out of the house, but I don't know what he is taking away from it. Many professionals have told me his only chance at advancing is through one-on-one ABA therapy. I think I believe it to be true now. I'm not seeing Andy progress anywhere as of now. Whereas before with ABA therapy, he progressed a small amount, which is better than nothing.
I am very stressed with all of this new red tape to deal with and going back into unknown territory. The super cold 0 degree weather is also very non-motivating and makes me so tired. I continue to try and set small goals for the week, so that I can feel like I am accomplishing something.
Tuesday, February 3, 2015
Andy had a Snow Day
On top of all this, my daughter quickly developed the stomach flu, which I then got several hours later. We were both so miserable the whole evening. I have been scrubbing my hands and keeping my distance from Andy. I'm praying he will not get this too! He isn't showing any signs just yet, so hopefully we will be lucky on this.
I was able to keep Andy busy with beads and other toys that he can keep fidgeting with his hands, like play food. He also likes his piano toys and toys that play music. Luckily, my husband was able to help out with him a bit today, because my stomach was hurting to badly it was hard to stand up.
It will be back to school tomorrow, so Andy should enjoy that. His friends are always missing him too, when they don't get to see him. If he doesn't end up getting this flu, I will be absolutely thrilled.
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