Insurance

[freezorburn]

Is anyone else starting to feel the effects of the uncertainty in the health insurance industry?

I bought insurance on the exchange when I returned to the states about 2 years ago. Today I got a letter from my insurance company saying that they will no longer be offering individual health plans in my area. I just spent a ton of time last winter reviewing all the different plans to figure out which one worked best for us, and now it's back to the drawing board. At least they gave me plenty of notice.

I know there are other options -- but this is pretty disappointing. We will almost certainly have to change doctors across the board -- GP, ped, etc. And I'm keeping my fingers crossed that this won't mean a disruption in ABA therapy for DS. It's been super-helpful.

We probably qualify for Medicaid but all I hear about Medicaid are waitlists upwards of 2 years. I think that's unacceptable.

I can get insurance through my job, and I might be able to add enough hours in the fall to be able to add DS to the plan, so I'm going to look into that. Probably the most expensive option is to shop the exchange again, but if we did that then at least I would be able to choose a plan that would enable us to keep our doctors.

[auntie]

I'm terrified.

Between having a young adult son who will age off his dad's insurance in 2 years and a dad who could potentially be headed for a nursing home sooner rather than later- the tomfuckery in Washington is feeling very real.

In my state, Medicaid for disabled children is not means-tested for parental income or assets. If there's a waitlist, get on it.

I expect the Medicaid cuts will be all the more painful in the context of the DOE's lack of commitment to public education and IDEA but I'd still get on the list.

[freezorburn]

Oh, I think I said something confusing. I don't think there's a wait to get on Medicaid. There are income requirements but that's all I know.

What I meant to say in my late night delirium is, there are long wait lists for DX and services for people on Medicaid. For them to cover ABA therapy, DX must be done at a "Center of Excellence." Waitlists for those are up to 2 years. Then probably another long wait for ABA. Another autism mom tells me that practices cap the number of Medicaid patients they take, so they wait for everything. It's a joke. DS would be done with grade school by the time we lined him up with a new therapist, if we went that route.

We had gotten DS' diagnosis privately, before I knew about any of this COE stuff. He is 5 now, and perhaps it makes sense to have him re evaluated at age 7 or 8. But if there's a way to avoid a gap in therapy, that's my preference. Even if we have to pay through the nose for it.

[pipsqueak]

Pip is on Medicaid but I think it's an income based qualification since ds1 was also on Medicaid until the end of the year after he turned 19 - something like that.

Dh and I have no option other than the marketplace or private purchased as neither of us has a job that offers medical insurance. The first year or two of ACA was great, but these past 2 years with more and more companies pulling out has been a bear to choose.

Dd isn't even covered by insurance this year. Partially her fault for not enrolling early enough for us to add her back in with us. She found out on the last day to enroll that she makes too much for Medicaid but not enough to qualify for help from the marketplace. Now she's changed states and jobs so checking on medical coverage is on her to do list.

I'm kind of scared to see what next year's insurance situation will look like.

[macchiatto]

I am extremely nervous about this, between my MS and my $6900/mo medication for that (plus other related expenses) and Leo's therapies et al, it is tough. He does have Medicaid as secondary. It's income based but I might try for TEFRA; I don't really understand what's going to happen there.

[chickypoo]

Medicaid is income based. Medicaid waiver is not. If you get the Medicaid waiver you get Medicaid because of senate bill 30. I'm not sure what exactly qualifies a child as disabled though, which is how you get the waiver.

[freezorburn]

Well I decided that I might drive myself crazy researching our options and not really figure anything out ... other than it seems that people on Medicaid seem to spend crazy amounts of time on wait lists.

So I bit the bullet and talked to my manager about getting another shift, so that I had enough hours to be able to add DS to the union/employer health insurance plan. Our department is maxed out on hours, so she asked the store manager if there was need in other departments that would fit my schedule requirements. They came back and said the store could really use someone doing a dedicated shift of cleaning and maintenance. And while it's not nearly as fun as what I currently do, they'll let me set my own hours -- I can work the 4-6 hours that I need for DS's insurance and start and end when it suits me, I just have to let them know. I won't have to jockey with more senior people for schedule preference, as I would if I were to be assigned to another department. So I'll still spend 70% of my time doing floral, and one short shift a week essentially being a floater. Which sounds ideal to me. And hopefully this means I will still have time to figure out my longer term plans.

I'm still nervous about what this might mean for DS's ABA therapy, and that's the next bit of research that I need to do. But I figure even if we end up paying an out-of-network rate to keep our provider, we may end up still saving money or breaking even, just based on the fact that I don't have to pay the premium.

[chickypoo]

If there's a waitlist for something that you are eligible for it means you just need to get on it asap, not give up on it. Even if it's years, you don't want to pass it by bc of the wait and then need it later and have to start at the beginning.
And you never know what can happen. Our waiver program was a several year wait but they just revamped it and now it's months. And while we are on the waitlist we get respite. Or we are supposed to get it, we haven't had luck yet finding someone good enough.

[freezorburn]

Jul 28, 2017 6:12:08 GMT -5 chickypoo said:

If there's a waitlist for something that you are eligible for it means you just need to get on it asap, not give up on it. Even if it's years, you don't want to pass it by bc of the wait and then need it later and have to start at the beginning.
And you never know what can happen. Our waiver program was a several year wait but they just revamped it and now it's months. And while we are on the waitlist we get respite. Or we are supposed to get it, we haven't had luck yet finding someone good enough.

I know this. I just hate the idea of interrupting DS's ABA therapy because of all this insurance nonsense. We waited 9 months to work with his current provider. If we have to give them up who knows what will happen. We never even heard back from the other 3 wait lists we were on, and it's 2 years now since I initially contacted them.

And, I do believe there's a difference between reasonable wait times, due to logistics and availability, and finding the right fit, and then there are really frustrating wait times that are really more about systemic problems. When I hear about limited spots of kids on Medicaid ... my heart breaks. We as a society can/should be doing more for these kids. I just have my one that I'm responsible for, but I do also feel strongly about collective responsibility, and I worry that we are letting so many kids down in so many ways.

I am hopeful, though. Every day I meet people who are doing what they can to help and make things better. Teachers, health care workers, students who want to help make the world better. I think things do improve over time. I'm just impatient I guess.

[chickypoo]

Jul 28, 2017 14:50:28 GMT -5 freezorburn said:

Jul 28, 2017 6:12:08 GMT -5 chickypoo said:

If there's a waitlist for something that you are eligible for it means you just need to get on it asap, not give up on it. Even if it's years, you don't want to pass it by bc of the wait and then need it later and have to start at the beginning.
And you never know what can happen. Our waiver program was a several year wait but they just revamped it and now it's months. And while we are on the waitlist we get respite. Or we are supposed to get it, we haven't had luck yet finding someone good enough.

I know this. I just hate the idea of interrupting DS's ABA therapy because of all this insurance nonsense. We waited 9 months to work with his current provider. If we have to give them up who knows what will happen. We never even heard back from the other 3 wait lists we were on, and it's 2 years now since I initially contacted them.

And, I do believe there's a difference between reasonable wait times, due to logistics and availability, and finding the right fit, and then there are really frustrating wait times that are really more about systemic problems. When I hear about limited spots of kids on Medicaid ... my heart breaks. We as a society can/should be doing more for these kids. I just have my one that I'm responsible for, but I do also feel strongly about collective responsibility, and I worry that we are letting so many kids down in so many ways.

I am hopeful, too. Every day I meet people who are doing what they can to help and make things better. Teachers, health care workers, students who want to help make the world better. I think things do improve over time. I'm just impatient I guess.

But you're not giving anything up by being on a waitlist. You don't even have to give things up if they don't cover it once you're approved. But I would hate to pass on it then lose all the support you have and be SOL with everything.

[freezorburn]

I get all that. I just have to figure out the money part. I'm sure things will work out somehow. It's just a PITA.

[macchiatto]

I was just given the paperwork to get on the waiting list for ABA here. Supposedly the waiting list is "at least two years."

[freezorburn]

Aug 15, 2017 22:16:40 GMT -5 macchiatto said:

I was just given the paperwork to get on the waiting list for ABA here. Supposedly the waiting list is "at least two years."

Is this just one provider's wait list? Or is it something insurance related?

[macchiatto]

Aug 16, 2017 2:01:37 GMT -5 freezorburn said:

Aug 15, 2017 22:16:40 GMT -5 macchiatto said:

I was just given the paperwork to get on the waiting list for ABA here. Supposedly the waiting list is "at least two years."

Is this just one provider's wait list? Or is it something insurance related?

I don't think so; it was his DDSN case manager who told me about the waiting list. We have a ridiculously low Medicaid reimbursement rate in my state that, from what I understand, contributes to the problem.

[chickypoo]

We just had a short neuropsych reassessment and are going forward with an autism diagnosis and ABA. Hopefully there aren't too many hoops and out ins pays for home based therapy.

[waverly]

chickypoo, I'm glad you are getting some answers and therapies in place. Good luck. I too hope for you that it goes smoothly and as inexpensive as possible.

[macchiatto]

chickypoo, I hope so, too. Let us know how it goes. How are you doing?

[chickypoo]

Thanks guys. I feel like I'm pretty much way past the end of my rope with life, but having the three girls in school has helped me feel more centered and able to start getting my home back in order and breath for a minute. J goes to preschool next month so I'm considering seeing if there's any way I can start seeing a professional to help with my anxiety and stuff. Of course with his 2.5 hours 2 days a week school the chances are probably pretty slim.

[chickypoo]

Oh, macchiatto, I'm not sure if this helps at all so I wasn't even going to say anything, but we were told about ABA in a way that made it seem like our options were only center based and with a long waitlist. I ended up finding out that a Chicago organization is expanding into our state and there is no waitlist. But the dr had no idea this was happening and is excited about it. Could there possibly be other options for you that maybe just aren't on their radar at this point?
Or are you saying it's just all about funding?

[sahara78]

macchiatto, to echo chickypoo, we found crazy differences in the waiting lists for the ABA providers in our area. The first I called said 9-12 months, while the second has immediate openings. Hopefully you can find a provider sooner.

[freezorburn]

macchiatto ... it's my understanding, at least in my area, that many providers keep separate waitlists for Medicaid clients. Because as you said, reimbursement tends to be lower so they can only afford to have so many Medicaid clients at a time. Maybe this is what the case worker was referring to.

You mentioned that Medicaid was secondary, though. Have you checked with your primary insurance company if ABA is covered? If it is, they may also have a list of in-network providers and the waitlists might also be a different story.

[macchiatto]

freezorburn, chickypoo, sahara78, Hmm ... I was told about it in a way that indicated there were no other options, too (both by his DP and his case manager). I guess I could ask around? I feel like we have our hands full therapy wise for right now anyway but I could start looking into that before long. I've also gotten mixed advice on whether ABA makes sense for him or not.

[freezorburn]

Aug 19, 2017 18:51:55 GMT -5 macchiatto said:

freezorburn , chickypoo , sahara78 , Hmm ... I was told about it in a way that indicated there were no other options, too (both by his DP and his case manager). I guess I could ask around? I feel like we have our hands full therapy wise for right now anyway but I could start looking into that before long. I've also gotten mixed advice on whether ABA makes sense for him or not.

I think it never hurts to make a few phone calls. Start with the insurance company, ask them what's covered and who is in network near you. If you get that far, then start approaching those people and ask about the status of their waitlist and what is their intake process. Ask if someone can just review your child's diagnosis and tell you whether the services they offer are appropriate for your child, or if they think you are barking up the wrong tree.SaveSave