Affordable Care Act and the war on Autistic Kids

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Affordable Care Act and the war on Autistic Kids

Nicholas Angel: How could this be for the greater good?
Neigh­bour­hood Watch Alliance: [all together] The Greater Good.
Nicholas Angel: Shut it!

Hot Fuzz 2007

Autism is a dis­or­der, really a neu­ro­log­i­cal con­di­tion that is typ­i­cally diag­nosed early in child­hood that is char­ac­ter­ized by huge dif­fi­cul­ties in com­mu­ni­ca­tion and form­ing rela­tion­ships with other peo­ple. These chal­lenges are due to the way the peo­ple with this con­di­tion use lan­guage and inter­pret abstract concepts.

My son is a four year old on the autism spec­trum. He sits in the mild side, and has been in treat­ment for a while to treat his var­i­ous devel­op­men­tal strug­gles. He is far from alone in these strug­gles. The autism spec­trum is a wide range of sever­i­ties of this dis­or­der but it is said that more than 1 in 100 kids (more like 1 in 88) sits on the spec­trum and requires some kind of treat­ment. These treat­ments can be shock­ingly costly.

Many of these treat­ments have been cov­ered by our insur­ance com­pany as every ther­apy he has been in was pre­scribed by a med­ical pro­fes­sional. He has been to neu­rol­o­gists, speech ther­a­pists, occu­pa­tional ther­a­pists, all kinds of stuff. The co-​pays alone would bog­gle your mind.

Then we come to today. He goes to one of his two reg­u­larly weekly sched­uled speech ther­apy appoint­ments that, until this week has been cov­ered. The health care provider puts in an autho­riza­tion request for treat­ment before his appoint­ment (as is their nor­mal pro­ce­dure), and it is denied. That is strange, why now, why not a week ago?

Some­thing strange is afoot at the Cir­cle K you say?

Wait for it, this gets worse.

It turns out that under the Afford­able Care Act they, accord­ing to the insur­ance com­pany, they are required to only cover these types of ther­a­pies for “restora­tive rea­sons.” What is a restora­tive rea­son you ask? They can cover more but it is at their dis­cre­tion. So, what com­pany would do so if they don’t have to? Well cer­tainly not this one.

Put another way if he had been in an acci­dent and lost the abil­ity to speak they would help, oth­er­wise they won’t. Autis­tic kids are out of luck I guess, at least to go through a qual­i­fied pri­vate insur­ance cov­ered speech therapist.

I was angry for a vari­ety of rea­sons mostly because this is land­ing on us with no warning.

So, I asked, what is going on? When did this change?

Oh a let­ter was sent out 3 days ago? On Fri­day, and today is Tues­day? Nice, I guess I haven’t got­ten or read that yet but ok.

I asked the ques­tion, what are these kids sup­posed to do? Have no shot in life? Med­ical pro­fes­sion­als can pre­scribe a treat­ment and unless you can afford the $250-$400/week in cost out of pocket your kid is just out of luck?

No, that isn’t the case, the insur­ance com­pany rep­re­sen­ta­tive says. I can appeal (which they told me would in all like­li­hood be denied but I can do it), or I can go to the local school sys­tem depart­ment of spe­cial education.

So let’s review:

  • Cov­ered last week not cov­ered today
  • Costs of my pol­icy go up year over year
  • Out of pocket just increased by at least $1000/​month for a pro­ce­dure pre­scribed by a med­ical pro­fes­sional (and that doesn’t include all the increases in copays elsewhere).
  • Cov­er­age is shift­ing away from treat­ing those with diag­nosed dis­abil­i­ties, sort of.
  • Because of his age he might be cov­ered merely by an already over­spent pub­lic school sys­tem accord­ing to the insur­ance com­pany (the school dis­trict disagrees).

Put another way the ACA through some con­vo­luted process just shifted what should be a med­ical pro­ce­dure onto the school system?

I guess they wanted the fed­eral deficit num­bers to look bet­ter for the kids they have to cover through the sub­si­dies? Could that be the case? Surely not…No, they would never for­get to tell the whole truth right?

Does that seem like how things are sup­posed to work?

It appears as though we are play­ing a shell game of which part of the gov­ern­ment goes into debt to do the job it was design to do. Also this brings to mind what qual­i­fi­ca­tions the school sys­tem has to do ther­a­peu­tic treat­ments that should be done by some­one trained specif­i­cally for this pur­pose. Or is the Depart­ment of Edu­ca­tion just work­ing its way into all aspects of our life so that it never gets cut back and only grows?

What­ever the rea­son is this mon­strously large bill that was sup­posed to bring down costs is cer­tainly hav­ing issues prov­ing its worth beyond some kind of pro­ce­dure requir­ing a band aid or the most cur­sory of treatment.

As an inter­est­ing PS to this story. I was on twit­ter vent­ing about this and got pounded by sev­eral peo­ple from one of the two major polit­i­cal par­ties. One state­ment said, basi­cally, I didn’t get it and that it was all for the “greater good.” Another insane defender of all things done by one party said that, essen­tially, not that long ago no one got anything.

The “no one got any­thing” state­ment is inter­est­ing because instead of fix­ing the prob­lem by mak­ing sure every­one gets some­thing we are strip­ping cov­er­age on an obvi­ously pre-​existing con­di­tion and blam­ing cor­po­rate greed. I am my wits end with the par­ti­san garbage. We no longer care about solv­ing prob­lems in this coun­try merely about assign­ing blame. We do this while par­ents have to fig­ure out how to help the very small chil­dren that we are sup­posed to be doing all of this to help. I will find a way to make sure Emmit gets what he needs, but it sure would be nice to be able to keep the cov­er­age I liked, with­out that price going up yet again or cov­er­age being reduced even fur­ther, but I can I can keep my doc­tor if I pay for it out of pocket while pay­ing the insur­ance com­pany to do less with more.

I guess we hoped, and we got change.

Tim I. PhD

–Author of the best­selling novel For­est of Assassins

Ama​zon​.com Widgets

Update: DTG: “The Greater Good” Boy that argu­ment sounds familiar:

*********************************************************************

The name niche mar­ket prin­ci­ple applies to DaTipJar.

For a Don­ald Trump the 22K that would cover my expenses for the and the extra $10K that would pay for the roof, car, floor kitchen and bath­room repairs that I had to put on plas­tic would be noth­ing and if my traf­fic was the size of a Drudge get­ting enough peo­ple to kick in to cover those bills would likely not be an issue.

But I have to take things as they are so if you like what you see here includ­ing my paid writ­ers like Tim Imholt and have a lit­tle extra you can spare. I’d appre­ci­ate it if you would hit DaTipJar





My goal for 2015 is Twenty Two grand which will give me a nom­i­nal liv­ing doing this.

[olimome­ter id=14]

That gets all the bills paid. (includ­ing my writ­ers like Fausta) If I can get to Forty Thou­sand I can afford to travel out­side of New Eng­land and/​or hire me a blog­ger to help me get it done.

Con­sider Sub­scrib­ing 100 Sub­scribers at $20 a month will get the job done and then some.

Choose a Sub­scrip­tion level
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Addi­tion­ally our sub­scribers get our pod­cast emailed directly to them before it show up any­where else.

If you could kick in I’d really appre­ci­ate it.

Nicholas Angel: How could this be for the greater good?
Neighbourhood Watch Alliance: [all together] The Greater Good.
Nicholas Angel: Shut it!

Hot Fuzz 2007

Autism is a disorder, really a neurological condition that is typically diagnosed early in childhood that is characterized by huge difficulties in communication and forming relationships with other people. These challenges are due to the way the people with this condition use language and interpret abstract concepts.

My son is a four year old on the autism spectrum. He sits in the mild side, and has been in treatment for a while to treat his various developmental struggles. He is far from alone in these struggles. The autism spectrum is a wide range of severities of this disorder but it is said that more than 1 in 100 kids (more like 1 in 88) sits on the spectrum and requires some kind of treatment. These treatments can be shockingly costly.

Many of these treatments have been covered by our insurance company as every therapy he has been in was prescribed by a medical professional. He has been to neurologists, speech therapists, occupational therapists, all kinds of stuff. The co-pays alone would boggle your mind.

Then we come to today. He goes to one of his two regularly weekly scheduled speech therapy appointments that, until this week has been covered. The health care provider puts in an authorization request for treatment before his appointment (as is their normal procedure), and it is denied. That is strange, why now, why not a week ago?

Something strange is afoot at the Circle K you say?

Wait for it, this gets worse.

It turns out that under the Affordable Care Act they, according to the insurance company, they are required to only cover these types of therapies for “restorative reasons.” What is a restorative reason you ask? They can cover more but it is at their discretion. So, what company would do so if they don’t have to? Well certainly not this one.

Put another way if he had been in an accident and lost the ability to speak they would help, otherwise they won’t. Autistic kids are out of luck I guess, at least to go through a qualified private insurance covered speech therapist.

I was angry for a variety of reasons mostly because this is landing on us with no warning.

So, I asked, what is going on? When did this change?

Oh a letter was sent out 3 days ago? On Friday, and today is Tuesday? Nice, I guess I haven’t gotten or read that yet but ok.

I asked the question, what are these kids supposed to do? Have no shot in life? Medical professionals can prescribe a treatment and unless you can afford the $250-$400/week in cost out of pocket your kid is just out of luck?

No, that isn’t the case, the insurance company representative says. I can appeal (which they told me would in all likelihood be denied but I can do it), or I can go to the local school system department of special education.

So let’s review:

  • Covered last week not covered today
  • Costs of my policy go up year over year
  • Out of pocket just increased by at least $1000/month for a procedure prescribed by a medical professional (and that doesn’t include all the increases in copays elsewhere).
  • Coverage is shifting away from treating those with diagnosed disabilities, sort of.
  • Because of his age he might be covered merely by an already overspent public school system according to the insurance company (the school district disagrees).

Put another way the ACA through some convoluted process just shifted what should be a medical procedure onto the school system?

I guess they wanted the federal deficit numbers to look better for the kids they have to cover through the subsidies? Could that be the case? Surely not…No, they would never forget to tell the whole truth right?

Does that seem like how things are supposed to work?

It appears as though we are playing a shell game of which part of the government goes into debt to do the job it was design to do. Also this brings to mind what qualifications the school system has to do therapeutic treatments that should be done by someone trained specifically for this purpose. Or is the Department of Education just working its way into all aspects of our life so that it never gets cut back and only grows?

Whatever the reason is this monstrously large bill that was supposed to bring down costs is certainly having issues proving its worth beyond some kind of procedure requiring a band aid or the most cursory of treatment.

As an interesting PS to this story. I was on twitter venting about this and got pounded by several people from one of the two major political parties. One statement said, basically, I didn’t get it and that it was all for the “greater good.” Another insane defender of all things done by one party said that, essentially, not that long ago no one got anything.

The “no one got anything” statement is interesting because instead of fixing the problem by making sure everyone gets something we are stripping coverage on an obviously pre-existing condition and blaming corporate greed. I am my wits end with the partisan garbage. We no longer care about solving problems in this country merely about assigning blame. We do this while parents have to figure out how to help the very small children that we are supposed to be doing all of this to help. I will find a way to make sure Emmit gets what he needs, but it sure would be nice to be able to keep the coverage I liked, without that price going up yet again or coverage being reduced even further, but I can I can keep my doctor if I pay for it out of pocket while paying the insurance company to do less with more.

I guess we hoped, and we got change.

Tim I. PhD

-Author of the bestselling novel Forest of Assassins

Amazon.com Widgets

Update:  DTG:  “The Greater Good” Boy that argument sounds familiar:

*********************************************************************

The name niche market principle applies to DaTipJar.

For a Donald Trump the 22K that would cover my expenses for the and the extra $10K that would pay for the roof, car, floor kitchen and bathroom repairs that I had to put on plastic would be nothing and if my traffic was the size of a Drudge getting enough people to kick in to cover those bills would likely not be an issue.

But I have to take things as they are so if you like what you see here including my paid writers like Tim Imholt and have a little extra you can spare.  I’d appreciate it if you would hit DaTipJar





My goal for 2015 is Twenty Two grand which will give me a nominal living doing this.

Olimometer 2.52

That gets all the bills paid. (including my writers like Fausta)  If I can get to Forty Thousand I can afford to travel outside of New England and/or hire me a blogger to help me get it done.

Consider Subscribing 100 Subscribers at $20 a month will get the job done and then some.

Choose a Subscription level
Beanie : $2.00 USD – weekly
Cap : $10.00 USD – monthly
Hat : $20.00 USD – monthly
Fedora : $25.00 USD – monthly
Grand Fedora : $100.00 USD – monthly

Additionally our subscribers get our podcast emailed directly to them before it show up anywhere else.

If you could kick in I’d really appreciate it.