What follows is a long insurance rant. You may not follow it but I assure you, it’s rant-worthy.
We had a child we believed was autistic. He needed therapy ASAP. We were informed by our insurance company that in order for insurance to cover his services, we had to have an evaluation and diagnosis at one of their pre-approved Autism Evaluation Centers. The wait lists for these centers ranged from 1-2 years long. We got on as many wait lists as possible. In the meantime, what could we do with this child who urgently needed services? Insurance will only cover PT, OT and speech 30 sessions per year, combined, before all coverage stops, unless we have a diagnosis of autism. We learned this the hard way when coverage for our son’s feeding therapy was abruptly terminated.
We contacted a local ABA clinic, who told us about bridge authorization, a service provided by Lucet (who is somehow affiliated with our insurance company?) which would enable us to get him approved for services more quickly. If we got a comparable diagnosis from a psychologist on their other approved list, that diagnosis would give our son access to services temporarily, as long as he stayed on the wait list for the official Autism Evaluation Center.
We contacted one of the psychologists on the list and got on their wait list, which thankfully wasn’t nearly as long. As you already know we went through the whole damned evaluation process including an ADOS-2 and a bunch of other tests the insurance company requires for bridge authorization. After months of this bullshit, we finally got our diagnosis. ASD Level 2.
In the meantime, the pediatrician sent referrals to OT, PT and speech therapy so that we could start our son in services. He started about three weeks ago, and it was a race against the clock to get his official diagnosis before our 30 approved sessions ran out.
Now with his diagnosis, and following Lucet’s instructions to the letter, surely insurance will cover services, right? Right?
I think we all know where this is headed.
Enter this week. OT, PT and speech said the insurance company would not let them bill autism. My husband called the insurance company and they are acting like they never fucking heard of bridge authorization (they also had never heard of it when we first started this process. Spouse Weasel is an incredibly persistent insurance ninja and that’s the only way we got this process started in the first place.) My husband called Lucet and they explained, oh, bridge authorization is only for ABA therapy (which we have not yet decided on.) It has nothing to do with speech, OT and PT.
For OT, speech, and PT, the referrals the pediatrician wrote are not sufficient. He needs to call in and pre-authorize each one separately, and then our therapy provider has to conduct their own autism evaluation (I shit you not) and then they can bill to insurance. Because the fucking 20 page report we already have detailing my son’s diagnosis is just not fucking good enough.
We have 15 sessions left before coverage for therapy is terminated. It doesn’t count toward our out of pocket max, no discounted rate, nothing. If we don’t get this sorted out by then, therapy for my son will run us about $3,000 a month. I’ve looked at what we have saved so far toward a down payment on a house and that will get us through about 10 months.
And as the fucking cherry on top, my husband called the approved Autism Evaluation Center to check on the wait list. In January they told us the wait list was 7 months. Yesterday they sent us a letter (another fucking insurance requirement) saying the wait list is 7 months. It’s been 6 fucking months since they first told us 7 months.
That is the simplified version, it’s actually much more convoluted and my husband has intentionally spared me the more aggravating details. Guess how much work he’s been getting done lately? Guess who has to sacrifice her free time to watch our kid so my husband can pick up extra hours since he spends all fucking day on this bullshit?
I can confidently say that insurance companies intentionally deny services to disabled children. We have only gotten as far as we have because my husband is unusually intelligent, knows how to navigate insurance through his experience as a psychologist, and is extremely fucking stubborn. Everybody else is basically fucked. And even with all these advantages we have, they are still trying to fuck us as hard as possible. I’m so disgusted with the US health care system.