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Old 11-28-2012, 01:15 PM   #1
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Well, it's official...

...my insurance is denying coverage for my son's therapy. I am crushed.

The public schools can't/won't help because his need doesn't affect his education. We don't qualify for Medicaid, either. I am still desperately trying to convince DSCC (Dept of Specialized Care for Children) to reconsider our request for coverage for DS, but they don't cover feeding/GI problems and they are having a hard time connecting the dots between his eating and his heart problems (which is the only way they will provide help). Even if we jump through all the hoops, it will take WEEKS for approval and my son should be getting therapy twice a week. He has already been on a backslide with his eating - he hasn't eaten anything since noon yesterday - so I can't imagine the damage that being without help for so long is going to do. I am so sick. I don't know what to do...

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Old 11-28-2012, 01:22 PM   #2
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Re: Well, it's official...

I'm so sorry.
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Old 11-28-2012, 07:46 PM   #3
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Re: Well, it's official...

I'm so so sorry. That's horrible. I don't have any advice to offer, just . I hope that you get something figured out for your little man soon.
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Old 11-29-2012, 01:08 AM   #4
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Re: Well, it's official...

I'm so sorry. My heart goes out to you. That is devastating How could they not cover feeding problems. That is crazy and just plain wrong. Feeding is a huge medical concern. I'm so sorry. I hope they reconsider your request.

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Old 11-29-2012, 01:59 AM   #5
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Oh mama I'm so sorry. This may sound nuts, but have you tried contacting someone in other fields? For example, my midwife bartered. She knew tons of other doctors and resources in other fields, that would do the same for patents and kids in need. Where are you at? I'm sure you've tried everything, but I would like to try to help somehow

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Old 11-29-2012, 07:08 PM   #6
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Re: Well, it's official...

Praying for you and your boy mama!
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Old 11-29-2012, 11:26 PM   #7
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Re: Well, it's official...

Quote:
Originally Posted by jen_batten View Post
I'm so so sorry. That's horrible. I don't have any advice to offer, just . I hope that you get something figured out for your little man soon.
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Praying for you and your boy mama!
Thank you both.

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I'm so sorry. My heart goes out to you. That is devastating How could they not cover feeding problems. That is crazy and just plain wrong. Feeding is a huge medical concern. I'm so sorry. I hope they reconsider your request.
I can't tell you how many battles I've fought over the feeding thing. It drives me INSANE that so many places don't take it seriously. I was actually told once that we would have gotten coverage if my son had a G-tube, but they will NOT cover his therapy to keep him OFF of a G-tube? That is twisted. I hate it.

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Originally Posted by Hillargh View Post
Oh mama I'm so sorry. This may sound nuts, but have you tried contacting someone in other fields? For example, my midwife bartered. She knew tons of other doctors and resources in other fields, that would do the same for patents and kids in need. Where are you at? I'm sure you've tried everything, but I would like to try to help somehow

Sent from my Galaxy Nexus using DS Forum
I'm in IL, but I feel like I've explored every option I could possibly come up with short of winning the big lotto and paying for everything out of pocket. His main therapist (who I adore) called me and offered to give him private therapy sessions at a very discounted rate, but we can't afford it even so. At least, not at the frequency he is used to going, maybe once a month...but she was as crushed as I am because she KNOWS how difficult of a situation it is and what a complicated little guy my son is. They really bonded and it hurts to take that away from him, too.

I happened to be taking him to a well visit today and I spoke to his pediatrician about it. I'm not sure I understand the bartering system? but she said she'd write the insurance company a letter stating how necessary it is and offering to provide any medical evidence they need. The insurance company has seen most of that already though and they determined him ineligible because they saw his therapy as "maintenance" rather than "progress" (he has a pretty traumatic past with eating, in addition to complicated medical issues, so he moves slooooooooooow with progress).

At that same appointment, because of some other red flags, she decided to refer him to be tested to see if he falls into the autism spectrum. Obviously, the thought of that breaks my heart but on the same token, if he were dx with something of the sort perhaps that might open up more doors for him? I hate to wish for that...but...between that and the results from a genetic test that was done at Mayo, I guess I will just hope they find something bad enough to deem him *worthy* of help.
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Old 11-29-2012, 11:34 PM   #8
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Re: Well, it's official...

I have been following your story and I am so, so sorry for what you have been going through. I believe we were in the same due date club. Anyways, I can't imagine how frustrating that is, but I hope you get some answers and help soon
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Old 11-30-2012, 08:20 AM   #9
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Re: Well, it's official...

No suggestions, just sending prayers and hugs. Can't imagine how hard that is, and it shouldn't be.
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Old 11-30-2012, 07:00 PM   #10
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Re: Well, it's official...

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