So Sick of "The System"....Discussion

[DaisyFace]

I am so tired of watching insurance and funding issues determine the answers and courses of treatment for our children and families!

Is it really too much to expect that decisions be based upon what the child NEEDS ?

Why is "the system" so willing to let so many children and families slip through the cracks without the proper services and supports?

Doesn't it make more sense to invest a year or two of intensive treatment for a difficult child when they are a child....and possibly send them down a better road...

rather than paying to keep them incarcerated for years and years as an adult?

It makes no sense to me!

(Please feel free to add your thoughts....)

 

[keista]

I agree, and asked the intake counselor of the specialized program DD1 applied to, the same question. They ONLY take kids with "certain" behavioral issues. Don't know what the formula is, but NO Autism Spectrum Disorders (ASD) qualifies. DD1 WAS accepted, but she is on the mild end of behavior issues. They ONLY take kids that qualify for the state Healthy Kids program which is a step above Medicaid. They Do NOT take kids on plain Medicaid. Oh, then there must be similar programs for those kids since you would think that the lower economic status would put them even more 'at risk'?????? NOPE. None she knew of. but, this is just one program inside a program inside a program.

What really gets me is that 'the powers that be' have not made the connection between mental illness and incarceration rates, when the evidence is overwhelming. Found this article from 2009 which clearly puts the statistics into perspective.

http://www.nytimes.com/2009/03/03/us/03prison.html

 

[Shari]

Its not just our kids. Insurance has way too much control, in my humble opinion.

Insurance deemed that I was only allowed 20 physical therapy visits and 20 occupational therapy visits for ALL of my injuries from my accident. Benefits ended before I was able to even walk.

As it is, I may need additional surgery on my wrist. Surgery that could have been prevented with more aggressive therapy early on. Time will tell. I'm trying to avoid it.

 

[klmno]

Well, this was on the table for congress and I won't go into that due to it being political. Some proposals to "fix" it were considered "socialist" and many in our country still automatically think "communism" at the mere suggestion of changing anything pertaining to private companies' rights, even if it's solely an economic and health-related issue.

 

[DammitJanet]

Shari is right. Go figure that they could have helped me lose weight with surgery years ago when I was working but they denied me and now I have all these problems with the arthritis and the fibro and am now NOT working and am on disability. They still wont help me with the surgery. Oh one day they will replace my knees and my hips and probably do cardiac surgery...but the weight loss surgery...nope...lmao.

 

[KTMom91]

I asked about the weight-loss surgery, too, and was told I wouldn't qualify because I wasn't more than 100 pounds overweight. So now, I'm diabetic, with high cholesterol, high blood pressure, sleep apnea, bad knees, asthma, chronic pain...but I'm still not more than 100 pounds overweight. However, if I would just lose weight, everything would be fine. Really?

 

[keista]

many in our country still automatically think "communism" at the mere suggestion

What makes this thinking even worse its that most ppl haven't even got a clue as to what communism is and is not, in theory or in practice. GRRRRRRRRRRR

 

[klmno]

I don't know that k thru 12 schools in this country are even teaching that there's a difference between an economic system and a political system anymore. That's the first problem. People need to understand that socialism (economic system) doesn't equate to communism (a form of government) and that limiting or having more requirements on private companies or offering health care to all doesn't automatically jump to socialism. I'll stop there.

 

[AnnieO]

I'm right there with you.

We do not qualify for a public defender for Onyxx - because I make too much money.

Never mind all the other legal bills we must pay.

We asked for treatment before, and she ended up with a slap on the wrist for felony drug theft. DV? Another slap on the wrist. We even TOLD them we have private funding. But no. They'd rather she just get worse and worse and worse...

 

[flutterby]

Apparently, in Ohio CPS used to pay to send any child to Residential Treatment Center (RTC) or wherever if a mental health professional said they needed it. Except they were sending so many that the system quickly became overwhelmed - financially and in the number of kids they were dealing with. So to correct it? They go almost the exact opposite route and won't send anyone until they've been involved in the system, are violent, aren't safe to have in the home, etc. One extreme or the other. I don't know what happened to common sense. But when they're 18? Hey, you can kick them out and who cares if they don't have the skills to function as an independent adult.

I wholeheartedly agree with Shari. Insurance companies have had too much control for far too long. I don't see that changing anytime soon as no one seems to have the cajones to take them on and change the system.

/rant

 

[AnnieO]

Well, our former governor - the one who had some degree in psychology or somesuch - killed funding...

 

[timer lady]

The system is, in my humble opinion, a double edged sword. There's either too little or too much. If you have services there tends to be a lack of privacy &/or respect of you as a parent, a person. wm has a team of 17 mental health professionals; kt 10. Overwhelming to say the least.

To qualify for services when you need them is a journey in of itself. Jumping thru hoops, opening your family to intense scrutiny just to be told you have to wait x number of months or that your difficult child doesn't qualify.

Insurance companies have such a stronghold it's hard to believe that mental health parity laws have been passed in my state.

 

[flutterby]

Strickland did kill funding, which is especially heinous considering his profession (he was a prison psychologist for crying out loud!). However, according to CPS they stopped paying for those kinds of services in the way the were about 6-7 years ago, which predates Strickland. There was also an uproar that families were having to turn their kids over to CPS in order for their kids to get the treatment needed because insurance companies wouldn't pay and families couldn't afford it out of pocket. It made front page of the Columbus Dispatch on more than one occasion. My former state rep worked tirelessly to bring about mental health parity in this state, but it was so watered down by the time it got through all the committees that it might as well not exist.

 

[DammitJanet]

KT...I was well over 100 pounds overweight the first time two times I attempted to get the weight loss surgery and I BCBS insurance through my employer. The surgery was supposedly covered too. I met with surgeon, attended a series of classes at his office, did some exams and was very close doing the hospital paperwork and blood tests when I was notified that my insurance had denied me. I contacted them and they told me I didnt meet qualifications! I questioned them on this stating exactly what my medical conditions where but they said that they would rather do a waiting game and see how my medical situation played out over a period of time before approving this sort of surgery! After all, they had only been my insurance agent for 4 years so they would like to see how I fared for a few more years...lmao.

 

[DaisyFace]

KT...I was well over 100 pounds overweight the first time two times I attempted to get the weight loss surgery and I BCBS insurance through my employer. The surgery was supposedly covered too. I met with surgeon, attended a series of classes at his office, did some exams and was very close doing the hospital paperwork and blood tests when I was notified that my insurance had denied me. I contacted them and they told me I didnt meet qualifications! I questioned them on this stating exactly what my medical conditions where but they said that they would rather do a waiting game and see how my medical situation played out over a period of time before approving this sort of surgery! After all, they had only been my insurance agent for 4 years so they would like to see how I fared for a few more years...lmao.

Well, sure....

if you're really, REALLY sick...

it's cheaper for them

if

you

die.

 

[AnnieO]

I've had similar stuff happen!

Like... I had BCBS, but their maternity rider was around $180 a month on top of what I was already paying through the nose for, and then they upped my premium, did not tell me, and cancelled my coverage for being about $18 in arrears (no joking). I went online, found UHC, applied. Was turned down due to pre-existing condition: infertility.

BUT WAIT. I wasn't infertile, the whole thing was husband. The lady I talked to explained that since I took the Clomid, I was considered infertile and no one would touch me for at least 2 years. I asked if the doctor could justify and she said it would not be accepted.

Well. PFFT.

Then this year my company got a new insurer, and the rates we pay dropped significantly - enough for me to consider it (it's pre tax; the BCBS was an individual plan). It turned out to be a little more expensive than BCBS, but due to pre-tax withholding, much less expensive after all. Co-pay is lower. Maternity AND IVF SERVICES are covered. And, because it's a group plan, they can take their BS pre-existing infertility koi and jam it.

The insurance Onyxx is on through BM? is BCBS. They won't cover snot. In fact, about 95% of the time we get "she's not covered", it gets sent through again, suddenly she IS covered.

So here it is:
Short term: cheaper not to help the kids, let the parents handle it. (System: $0)
Mid term: parents aren't trained, kids turn into delinquents, parents get blamed. (System: $0, Parents: $50+ in court costs every time)
Long term: kids end up criminals, write books about their horrible parents. (System: $0, Taxpayers: $30,000/year, Parents: Unimaginable anguish)

 

[klmno]

So here it is:
Short term: cheaper not to help the kids, let the parents handle it. (System: $0)
Mid term: parents aren't trained, kids turn into delinquents, parents get blamed. (System: $0, Parents: $50+ in court costs every time)
Long term: kids end up criminals, write books about their horrible parents. (System: $0, Taxpayers: $30,000/year, Parents: Unimaginable anguish)

That's a pretty good synopsis! I guess I better tell difficult child to start on his book!

 

[InsaneCdn]

klmno... Where's that "like" button... ! oh, ya, it isn't on THIS forum.
Consider your post "liked".

 

[klmno]

Ha! I was going to use it for Step's post but couldn't so that's why I posted it over!