 |
This is me after a rousing day of battling with the
insurance company, aka "The Man". Note that I've lost
all appearance of sanity and that something's on fire in
the background. |
This is going to sound very anti-Republican of me, but I have now become an advocate for insurance and health care reform. In fact, I don't think that Obamacare went far enough.
Before all of my Republican friends out there start burning effigies of me, allow me to explain. Since my son's PDD-NOS diagnosis, I have discovered how little the insurance companies are willing to cover treatment. If my son had a medical problem that could kill him, like cancer, I could have checked my son into the hospital and started treatment almost immediately. However, since my son has a life-long disability that will not necessarily cause him any "medical" problems, they want to fight me every step of the way.
Here is what my son, and most children with autism, need - speech therapy to address the typical lack of speech (as in Jack's case) or delay in speech, occupational therapy to teach life skills, fine motor skills, and, in some cases like Jack's, help with sensory integration, and behavioral therapy to work on engagement and social skills. All children with autism need help to achieve their full potential.
 |
What I feel the need to consume after a long
day battling "The Man". |
There are two means to getting this therapy. First, there is private therapy. Second, there are government services to provide it. The Individuals with Disabilities Education Act (IDEA) provides two mechanisms to receive services. Part C, known as Early Intervention, or Babies Can't Wait in Georgia, requires states to create a means of identifying children with disabilities and developmental delays and providing early intervention services to address these delays. This is available for children ages birth until their 3rd birthday. Once children turn 3, they age into IDEA Part B, which requires public schools to provide a "free and appropriate education" for children with disabilities from age 3 to 21.
The problem with Early Intervention and Part B is that governmental organizations are subject to budget cuts. It is our most vulnerable citizens who suffer.
Of course, there is always private therapy. The problem with private therapy is two-fold. One, it's expensive. I mean, really expensive. We're talking $100/hour or more; I'm finding that more is the norm. For a family who has a child who requires multiple different therapies a week (Jack will receive 4 different therapies weekly), this is an overwhelming financial burden to pay out-of-pocket.
 |
| But seriously...this is what I REALLY feel like consuming. |
So, what about insurance? Well, as I'm finding more and more, insurance is a business. We pay hundreds of dollars in premiums a month not to get the equivalent in care. In particular, for therapies like speech, insurance often provides no coverage for developmental delays. Insurers consider speech, in particular, to be an "educational" problem and not a medical issue. In our case, it does provide coverage for autism spectrum disorders, though. However, most insurers cover a limited number of visits to therapy a year. In our case, it's 20. For those of you who have never had to put a child through therapy, I'll tell you that there are no disorders that can be treated with only 20 visits a year. Jack is to receive 1-2 one hour sessions each of speech and OT weekly.
After those 20 visits are up, you have a couple of choices. You can pay out-of-pocket and put a second mortgage on your house. Unfortunately, I've heard that this is not uncommon. Or, you can apply for a Katie Beckett waiver for Medicaid, which waives the income requirements for children who have disabilities with substantial medical costs. If you get Medicaid, you're in good shape.
Do you know what's really horrid? In the face of a life-changing diagnosis like autism, parents must choke back the tears because we have to fight for services and coverage for our children. We have to fight as though our lives depend on it, because our child's future does depend on it. Believe me, as I've learned, it is a non-stop fight and a full-time job unto itself.
Do you see where I think we might need some reform? There are multiple points in this process to possibly fail these children. The insurance companies have no incentive to provide treatment for our special needs children because many, like Jack, if untreated will not have more medical problems, but they won't progress, either.
Why should this be a concern? Obviously, I have a vested interest in seeing my son succeed, but why should you? Or, more realistically, why should you have a vested interest in seeing any special needs child succeed? The answer's simple...if 1 in 110 children right now have an autism spectrum disorder, by the time my son is in his 50s, it will be 1 in 110 adults. If these children aren't given the tools to help them achieve full independence, they will require more services (and taxpayer money) in the future. We will have to deal with this surge of autistic children entering the adult population in one way or another. On the other hand, if they can achieve independence and get a job, they'll be paying into the system instead of taking out of it. They will be contributing financially to our economy.
So why should insurers bear the burden? Because, like so many things, private businesses do this better. By providing full coverage for autism spectrum disorders, the estimated cost increase to premiums is only 1%. Remember, if 1 in every 110 children have an autism spectrum disorder, this doesn't seem like a huge increase to provide treatment to 1% of our population. It will cost more to provide 50+ years of adult services to my child than to provide intensive early intervention now.
We should also be advocating for increased funding to Early Intervention agencies and school systems. People complain when schools cut the music program, but schools cut special education services and without as many vocal complaints. Realistically, which can we do without, music or special education? Ideally, we'd have both. Ideally, we'd decrease funding to other programs and increase it to education, because we'll see no better return for our dollar for dollar investment than to put it into our children, regardless of whether they're special needs, autistic, or just the typical child.
So, there's my soapbox for the day. If you agree with me that this system seems to fail our children, I'd encourage you to do something about it. Go to
Autism Votes and see how you can get involved. Better yet, stay informed about what's going on in your school system. All of our children, not just mine, depend on it.