RUNNING OUT OF INSURANCE

Discussion in 'General Parenting' started by Fred's Mom, Sep 16, 2004.

  1. Fred's Mom

    Fred's Mom New Member

    HI, I HAVE A 6 YR OLD BOY THAT HAS SELECTIVE-MUTISM AND ODD. HE HAS BEEN TO DIFERENT DOCTORS AND HE IS CURRENTLY IN WEEKLY PLAY THERAPY AND ON 15MG OF LEXAPRO. THE THERAPY IS EATING UP HIS INSURANCE VERY FAST. HE HAS BCBS AND HAS A LIFE TIME CAP OF $10,000 ON HIS MENTAL HEALTH. BY THE END OF NEXT YEAR HE WILL BE OUTOF INSURANCE TOTALLY. AND THERE IS NO WAY HE WILL BE BETTER BY THEN. MY FIRST QUESTION FOR ANYONE OUT THERE IS, IS THERE ANYWAY AROUND THIS LIFE TIME CAP OF $10,000 THAT HE HAS. MY 2ND QUESTION IS, IS THERE ANYONE THAT DEALS WITH THIS DEFIANCY(WHICH I'M SURE THERE IS)
    AND HOW DO YOU DEAL WITH IT. THERE DOESN'T SEEN TO BE ANYTHING THAT WORKS WITH THIS CHILD FOR VERY LONG. THANKS FOR ANY ADVISE!! /importthreads/images/graemlins/smile.gif
     
  2. Coookie

    Coookie Active Member

    Joan,

    Welcome...I can't speak to the insurance issues but I would recommend that you read "The Explosive Child" by Ross Greene. The methods in this book have changed our family. My difficult child (gift from God) was/can be very defiant and like I said the methods in this book have worked for us.

    You also might want to post in the General Forum regarding the issues you are having with your son. You will get alot of really good support, care and info.

    Good luck, glad to see you and welcome again.

    Hugs
     
  3. mose

    mose New Member

    Apply for the "Katie Beckett Waiver" program through Medicaid. Did you know your child becomes eligible for Medicaid when the family private health insurance does not cover your child'€™s special needs.

    http://www.familyvoices.org/
    A parent's advocacy group if you need help getting a waiver under the Katie Becket bill.

    Information about this wavier.
    https://web.archive.org/web/2009010.../issues/children/publications/TEFRA/fact1.htm

    Good Luck,
    We got this wavier when my daughter used the max on our private HMO.
    mose
     
  4. wincha

    wincha New Member

    10,000 is a very small amount.

    have you got him help in his school with an iep?

    have you applied for ssi and medicaid for him?
     
  5. bria-maureen

    bria-maureen New Member

    i give my little girl, who is 6 years old and suffers from selective mutism, homeopathic remedies (from a great homeopath)and these have greatly helped her social skills and behaviour but she still is not talking to people other than a few family members but she is now talking very freely in front of other people just not to them directly.
     
  6. OTE

    OTE Active Member

    first- if you are within the income and assets limits for SSI apply for it now. Will take a long time to come through but will give you Medicaid plus a monthly cash pmt to you that will pay for therapy. With a child who is going to need services for a long time apply now.

    second.. re the medications.. go to needymeds.com and get the form for your son's medication. Again, look at the income limits. If the income limits aren't on the form or it's not clear call the 800 number listed and ask. Once your insur runs out they'll give you Lexapro for free- at least I was getting it for free. Note that you're dealing with the pharmaceutical co that makes it. So if he switches medications you'll need to re-apply probably.

    In terms of the play therapy.. ask the place where he's getting it if they have or know of any scholarship programs. And the term play therapy can be controversial to some people so you might want to re-word it when you're asking around. Basically it's group psychotherapy probably. Then start calling every place that you can find that offers what you want and ask if they know of any funding. In all honesty, I'd love to have my Pervasive Developmental Disorder (PDD) kid in some kind of therapy but it's just not covered so we do without. But you'll find that most hospitals and non-profit psychiatric clinics have a sliding scale fee schedule. So keep looking and asking everyone you talk to if they know of another place.

    And just out of curiosity... isn't the selective mutism in the arena of social phobia? I'm wondering because I didn't know they were using Lexapro for social phobia. There's another SSRI that is actually FDA approved for social phobia. But I'm sure many are used off label for it. As far as I know the only treatment for social phobia is a combination of SSRI and psychotherapy. I'm aware that other medications not meant to be used long term show a short term huge benefit but they're not considered useful long term because of the long term effects.
     
  7. bigblueagain

    bigblueagain New Member

    I am just now seeing this but wanted to respond to a couple of things.
    The $10,000 life cap is not unusual. That is actually a pretty typical cap amount. The employer who supplies the coverage can cap anything at any level they want. Some states mandated mental health coverage whether the employer is fully or self insured, but there is no way they can actually mandate a coverage amount. Believe it or not, insurance coverage is a benefit, not something an employer actually ahs to give. So I would think you could at least apply for the SSI, but dependent on family income until your difficult child is 18, you may not qualify. We never did even without mental health coverage until my difficult child turned 18.
    Secondly could the selective mutism not be considered a medical condition, therefore MEDICAL would have to cover, not Mental. Some folks don't understand there is a difference between the two. In fact most employers are now separating the two, that way they can limit the amount under mental health benefits much easier.
    At my current job the employers are all self insured, meaning it's their money. However they are ALL giving great mental health benefits by virtue of our company helping them. Sometimes members call us and bless us out, but in truth they are really really much luckier than most!
    bLUE
     
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