The Fox Theatre is hosting a special “Sensory Friendly” showing of their latest new Sesame Street Live Show – “Can’t Stop Singing”. While there aren’t any changes to the show itself there will be some extra supports for those with children challenged by Sensory hurdles. They describe the show as  ….

The presentation will not differ from the theater’s regular performance. However, the theater is providing production notes to parents ahead of time, to prepare their children for what to expect, should anything be a potential trigger. Quiet areas will be set up inside the venue to allow families to take a break for a few minutes and extra spacing will be incorporated in some seating areas to allow for room to move around. Gluten-free concession food options will also be made available. 

MY GREAT KID

 

While it might still be too much for some children, it’s a great opportunity for those of you who might’ve been wondering if your child could make it through this kind of show. Discounted tickets, gluten free options, quiet areas, extra space, production notes and a more understanding venue are all GREAT supports to take advantage of.

For a downloadable pdf of the flyer please click below

Sesame Street Live Sensory Night @ The Fox Theatre

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Today the  Michigan Autism Insurance Reform law went into effect – YAHOOOOO ……

BUT WAIT, NOT SO FAST

Remember folks, the insurance companies didn’t WANT this law. As a matter of fact they spent a lot of time and money fighting to keep it from getting implemented. Much as we’d like to think that now that the law is a reality they’d be our allies in helping our children get the help they need the reality is that, well, they’re going to be more like a bratty toddler stomping their feet at bedtime …….

So, much like the parent of a bratty …. or “spirited” …. child how do we have to respond?

WE ENFORCE THE LAW, HOLD THEM PUBLICLY ACCOUNTABLE

AND BUST THEM HARD WHEN THEY DON’T COMPLY!

Need proof the insurance companies are not that concerned about making your life easy?

Here’s a screenshot from my search today (Oct 15th)of a major insurance company’s list of providers at 12:28 pm ……

 

Hmmm……no BCBA’s. Gonna make getting ABA for my child pretty tough considering without a BCBA I can’t get it covered.

Well, then SURELY I’ll be able to find a Speech or OT therapist right?

Nope! Sorry! Out of luck my friend.

So is there such a shortage of providers in the state of Michigan that the insurance companies simply can’t find any?

NO.

Is there a shortage of providers in the state, compared to where it needs to be based on the numbers in the state, …. yes.

HOWEVER, and this is a BIG HOWEVER the insurance companies have not made getting providers for these new treatment areas a big enough priority and worse then that, they’ve so ridiculously low balled providers that they’re now having to scramble and renegotiate rates to get them on board.  They’re hiding behind excuses like “there was a misunderstanding” on the rates but the reality is that the “misunderstanding” was that the insurance companies thought they’d be more successful strong arming providers.

Why does this matter for parents?

The insurance company delays and foot dragging means fewer children can be helped, waiting lists will be longer, delays greater and the implementation of this legislation will be dragged out. Does anyone really think if the law would have included a $1 million fine for every day that the insurance companies didn’t have an appropriate number of therapists/BCBA’s on board we’d be seeing these …. shortages?

Yeah, me either.

Ok, so does this mean YOUR child can’t get help or therapy? NO!!!

Does this mean that your therapy won’t be covered? ABSOLUTELY NO!!!!

Does this mean you’re going to have to battle old school with your insurance company?

Sadly…..in many cases ….. YES!

So how do you fight Goliath?

Here’s a starter’s guide from first hand experience battling insurance companies both as a parent and a provider.

Let’s start here …….

  • Realize you’re going to have to battle and your notes will be the key to holding folks accountable and getting answers. Insurance companies love running folks in circles  and you need a roadmap to keep from getting confused and lost. Soooooo, pull out that brand new notebook and write “INSURANCE COVERAGE NOTES” across the cover in big letters. This is now your official transcript and record of EVERY call and exchange you have with the good folks at the insurance company. For those who like a more tech answer there’s a number of note taking and organizing programs out there (my personal favorites are Evernote and Workflowy*). What you use isn’t nearly as important as the fact that you use something to keep it all straight and organized!
  • What do you record? EVERYTHING!!!!!!!!
    • Phone Calls
      • Time of call
      • Duration of call
      • Name(s) of people you talked to and their departments, even their personal extension if you can get it.
      • Questions you asked them and their answers. Since it’s common when dealing with insurance companies to get different answers from different people it’s not a bad idea to make sure you put WHO told you WHAT next to their comment.
      • If they say they’ll send you something or get back with you …. find out WHEN and write it down.
    • Letters/Emails/Texts/Pony Express/Smoke Signals
      • Anything you get in non-voice format DATE the literature the day you get it and file it with your stuff
      • If this is something you’ve been waiting to receive it’s a good idea to go back into your notes and put a “rec’d: date” next to it in your notes. This lets you know when you review your notes that you actually GOT what they sent you
  • If you don’t already have one get either a filing cabinet or (if you’re optimistic) a small filing box. Seems like overkill? Not for a moment my friend because you are going to have a TON of paperwork, bills, letters, explanation letters, denial letters, approval letters, reports, etc. that you’re going to  HAVE TO KEEP TRACK OF AND BE ABLE TO FIND. If you try to do this on the fly you’ll not only get buried and confused you’ll realize that the one CRUCIAL letter you HAVE to have …… probably got lost in the back of your car and tossed with a crumpled Happy Meal box.
So, what do you ask when you call the insurance companies to get  young junior the therapy he needs?
First of all, remember that the person you’re talking to on the other end of the phone isn’t making the rules and doesn’t want to give you a hassle (usually). Many times they’re also your best ally in trying to get the help, information and coverage that you need. Rules are rules, but you’d be SHOCKED how much can get covered or how much easier your process can be IF you have an ally on the other end of the phone. So…..
  • Be nice
  • Be polite
  • Stay calm
  • Say “please” and “thank you”
  • Be firm but nice
  • Be persistent but nice
  • Be a pain in the butt? Sure, but do it nicely
  • Remember, your goal isn’t winning an argument it’s getting your child covered (good GOD is this a hard one to remember!)

Here’s a starter list of questions ….. customize as you need to ……

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Michigan Autism Insurance Reform Has Passed

Autism Insurance Reform Is Signed Into Law By Lt. Governor Brian Calley!

When: April 18th, 2012

Where: The Governor’s Mansion – Lansing, Michigan

F.A.Q. Regarding The New Laws

The Three New Michigan Autism Insurance Reform Bills

S.B. 981

S.B. 414

S.B. 415

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MIRS BREAKING NEWS: Autism Insurance Reform Package Clears Senate — 1:15 p.m.

The Senate today passed a three-bill package on autism insurance coverage championed by both Gov. Rick SNYDER and Senate Majority Leader Randy RICHARDVILLE (R-Monroe).

The bills are SB 0414, SB 0415 and SB 0981. SB 0414 passed 29-9, with all the no votes coming from Republicans. SB 0981 passed 28-10.

Sen. John GLEASON (D-Flushing) lauded Lt. Gov. Brian CALLEY, whose daughter has autism, for taking the lead on the effort.

“You have become the face of this issue . . . because you were bold enough, really courageous enough, to put your family issues before 10 million Michiganders,” Gleason said.

The package moved out last week from the Senate Health Policy Committee (See “Autism Coverage Bills Sent to Senate Floor,” 3/8/12).

Senate Appropriations Chair Roger KAHN (R-Saginaw) lost amendments to the bills that would sunset the proposed law on Jan. 1, 2015.

“What is so difficult about a sunset?” he asked. “It allows us the opportunity to revisit the issue.”

On SB 0981, Kahn’s amendment capped spending at $30 million. He said it would limit “the amount of damage this bill will do in attempting to do good.” That also failed.

He raised his concerns about revenues coming in below estimates, as he’s done for several years. He said the bills are “important to me,” but it’s important not to “rob” those suffering from ailments like hemophilia from funding, as well. He said that the administration’s estimate could be low, arguing that similar legislation cost $80 million in Minnesota.

“Members should know this is an increase and ongoing cost, undefined but certainly increasing substantially,” Kahn said.

Richardville won amendments to each bill that would make the law go into effect on Oct. 1.

SB 0415 sponsor Sen. Tupac HUNTER (D-Detroit) said today “marks an important milestone in the Senate, but more importantly, for Michigan families.” He said he was approached five years ago by a constituent whose child has autism, which inspired him to introduce legislation.

An attempt by Sen. Rebekah WARREN (D-Ann Arbor) to add mental health parity to the bill via a substitute was shot down on a 18-20 record roll-call vote. She said it would “enhance this compassionate legislation.” She said she is “proud” to vote for the autism
Click here to read the exciting conclusion ….

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