This Makes No Sense!

[Christy]

I'm needing to vent so bear with me!

In the past my son has had major issues with therapy. He hates the confrontation nature of it and does much better with an indirect approach like play therapy, art therapy, therapeutic riding, etc. Twice he ran away from his former therapists office and we had to have the police out looking for him. I lucked into finding a wonderful program that offered one-on-one intensive behavioral support. He met with this worker who was more like a mentor than a therapist. They went on outings and did things together but at the same time discussed problems that would arise at home and in school. He called me frequently to see how things were going. It was incredible but now the state is taking away the funding for the program

I started looking for an alternative and found a program that offers in home therapy. It sounds great. I get a referral and a call back. The intake person asks me if we still have Blue Cross/Blue Shield and I say yes but explain that difficult child also has medical assistance due to his special needs adoption status. She says that BCBS won't cover it and ever though medical assistance is the payer of choice, MA follows the lead of the primary insurance provider and is denying us. She told me that if he was only covered by MA, she'd have us in touch with an in-home therapist by the end of the week. She then says that the only therapist at the psychiatrist's practice that is taking BCBS is the same therapist that caused difficult child to run screaming from the office. Does MA not see the stupidity in this? If we drop difficult child from our private insurance then they will be 100% responsible for all his medication, dr visits, etc...

So basically we are being penalized because we have too much insurance. This has come up a few times with hospitalizations where they wanted to transfer difficult child to another hospital and were unable to do so because BCBS only does authorizations during business hours and we were having a crisis on the weekend. I am looking into dropping difficult child from our insurance but I am not sure if you can do this if you have a family plan. I am also not sure if it is a good idea because I believe that BCBS is better when it comes to medical insure other than mental health.

Does anyone have experience with dropping their difficult child from their private insurance?

Thanks for reading,
Christy

 

[klmno]

When you get into the morre intensive treatments, like in home therapy, is usually when you need the local public agencies to get involved- succh as DSS, Department of Juvenile Justice, etc, unless you can get something covered by him being adopted. Yes, I also heard that if my son had been on medicaid forever that he would have access to more mental health coverage than my private insurance would provide.

As far as therapy itself, my son was like that until I found a younger male therapist who I talked with a couple of times before taking my son in. I explained to him that I thought my son needed to get a better attitude about tdocs before anything could be effective so they guy spent a coupple of months seeing difficult child weekly talking to him more like a buddy or mentor and it did help my son a lot as far as loosening up and getting to a point where he looked forward to going to the therapist because he could talk to him about "guy stuff" that I, as his mom, could never understand. LOL! There wasn't a lot of therapuetic gain but it was better than having to chase difficult child down and difficult child hating all tdocs.

FWIW, many of the efforts to help difficult child's through behavior oriented therapy are not very effective and sometimes can make the kid worse. Ask the tdocc if they will do another type of therapy besides behavior modification.

 

[BusynMember]

Oh, how sad and how right you are and I hope it changes. I'm so sorry. We deliberately make sure hub and I don't make enough to qualify for insurance because we need Medicaid. It's better than insurance in Wisconsin. I never dreamed I'd "play the sytem" to get benefits, but we have no choice. Hub doesn't make enough and I'm on disability and we couldn't afford anything if we had to buy insurance and pay $1000 deductables. My son is also adopted, but we never put him under insurance, even though we had it at one time. We always just had him under Medicaid. However, Medicaid isn't as good in all states as it is in Wisconsin.

I really feel badly for you. I truly hope we reform healthcare. The way it is now, it's just horrible and unfair. Keep us updated and let us know if you find a way around it. Do call social services and seek this help! Maybe try your local mental health clinic. I love my therapist from our county clinic. I like her more than the private ones I paid for! Your son may find a match as well. I agree a man is better for him. A young man would probably be best...one who doesn't use that "tell me how you feel" approach. CBT is good! Pervasive Developmental Disorder (PDD) kids are so concrete (my son is VERY concrete). Any therapy for him would do no good unless it was logical and very black and white and goal oriented.

 

[lmf64]

I didn't drop my son, I just didn't add him when I enrolled. He gets MA which covers everything. If I had to pay for his medications with the insurance I had it would have been almost $1000 a month and I only made $1800. Besides the insurance the company I worked for only covered 6 mental health appts. a year. UMMMMMMM not going to work folks. lol He sees his psychiatrist monthly, therapist every two weeks, and has a PCA and a Skills Worker, all covered by MA.

 

[totoro]

At this point I think most insurance hoovers.

Our therapist is using CBT for both girls, it is really sinking in, first thing to ever really have an impression especially on K.
She was able to tell her psychiatrist on Wednesday what the therapist is doing with her and how they are working to help her calm her brain down.

 

[JJJ]

We had to drop the kids from our insurance. We needed them to be 100% MA in order to access services.

 

[KTMom91]

I stopped working full-time so Miss KT would be eligible for Medi-Cal. They only counted my income, not the family income. You do what you have to do.

 

[susiestar]

been there done that, are there again. Jess was essentially "fired" from her neurologist without any notice because he doesn't like our insurance. If she has medicaid she would be fine but she doesn't. We are trying another child neuro, but until this last year the old neuro was the ONLY child neuro in the STATE. Yes, we are backward here in Oklahoma.

If the new neuro isn't good we will have to drop the insurance. husband was laid off so we may have medicaid in a month when his insurance ends. BUT Jess needs help yesterday, not in a few months.

For years while husband was in grad school he earned just barely enough as a graduate instructor to qualify for medicaid. If he made $300 more per month (at first, a year later it was if he made $300 more per year) we would have had to pay for insurance. And the graduate student insurance would cover a wife but NO kids.

So I did not work. I did a LOT of volunteer work simply because I would have gone bonkers without it.

It IS frustrating, but the medicaid we had paid for everything 100%. It even covered the 4 months of inpatient psychiatric hospital treatment Wiz had. The ONLY thing it did not cover was the battery powered nebulizer thank you needed. They provided ones you could carry but still needed to plug in. He couldn't even go on most field trips without major asthma problems so my mom and dad spent $200 on the battery nebulizer.

But $200 over 3 years of expensive medical problems was a pretty good deal, in my opinion.

I hope you can work this out.

 

[Christy]

Thanks for listening. It sounds like many of you have been in similar situations. It's pretty sad that we have such a screwed up system.

Christy

 

[DammitJanet]

Cory has been on medicaid his entire life. Even when I worked I didnt put him on my insurance because he was on medicaid because he got SSI and my income wasnt high enough to cut him off. I only got like 20 bucks a month in the check but I kept the medicaid which was the most important part.

Funny...to this day...cory used to think his check supported the family...lmao. Yeah...20 bucks supported us! His loser friends told him that when he was like 16! Said I should be giving him more of "his" check. Yeah...uh...NO!