I See The Potential

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.

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