Never Fear, MOM Is Here!

Some things in life are easy. Most are not. Trying to get help over the phone is one of those things that is definitely NOT easy.


Let me back up. About a month before school began, we began to experience more tantrums with Samuel. At first, we thought summer was coming to its “fun” end for him, and he was ready to get back into school. Then school started, and after a sufficient transition time had passed, the tantrums had not only continued, but gotten worse. Another month later, and we’re seeing more meltdowns than Scrat in the ice age. Trying to control the meltdowns is as about as easy as holding on to that evasive little acorn that poor Scrat can’t ever seem to catch.


The straw that broke the camel’s back was when we tracked Sam’s progress at school, and instead of the “awesome” day report he gave every day (meaning he didn’t get in any trouble), he was coming home more and more having had warnings and stop and thinks (school’s version of time-out). It was apparent this was not a matter of him just holding it together in school, then letting it out at home. Now it’s affecting his school work, in addition to compounding when he comes home. It was time to act.


It occurred to me that Samuel has 4 different areas of help at school every day. He receives speech, occupational therapy, special ed, and he has an aid with him at all times. All of those therapies are put in place via his IEP to help him function effectively at school. Things were difficult, but since difficulty kind of goes with the territory of autism, we just kind of dealt with it as it came up. When the meltdowns began increasing in both frequency and intensity, I had one of those “Ah-HA!” moments. Kind of a “DUH” moment too, but a revelation nonetheless. Sam had helps at school to help him function well at school, but he had no regular therapy to help him function effectively at home or in his relationships with his brothers, parents, or in public.


Thus, the search began for: A. what we needed to provide for him, and B. how we could provide what he needed, most specifically how we could provide financially. We can pretty much work out whatever time we need to, it’s the moo-lah that is extremely limiting. The search ended in a meltdown of my own. It went something like this:


Call insurance and ask about benefits for autism therapy.
Referred to state mental health program.
State mental health program tells me autism isn’t a mental health issue, it’s medical.
Referred back to insurance.
Re-stating my request to a new agent.
Confusion by new agent.
Referred back to state mental health program.
Argued autism isn’t mental, it’s medical as told to me by mental health.
Referred to main State Medical Assistance office instead.
Immediately referred to random agent who had to listen to me calmly yet with a shaky voice explain what I needed, what had happened in the phone tag, and then break down that I needed help NOW!
Referred to the MD State Dept. of Education.
Explain AGAIN to yet another person what I needed who had nothing to do with what I was looking for, and we both knew it.
Referred back to insurance.


                            LUNCH


Started all over again with insurance.
FINALLY got an agent who knew what the heck she was talking about and actually gave immediate helpful information.
Referred to another Dept. and told benefits available.
Got referral numbers for actual therapists in our network covered at 100%.


                            VICTORY!


One fight down, another to go.


There is a possibility that our insurance will cover the much sought-after ABA therapy that brought Sam so much success in the one year he had with it, but it requires more fight. I had to contact our physician and find out if he would be willing to write up a report that proved medical necessity of the program, as insurance does not view it as medically necessary and therefore, does not cover it as a legitimate therapy for autism. If he was willing, he then has to submit it to the agency who approves and sets up services. I got a call back from our doctor within the hour and he was willing to write the report and even set up an appointment to see him next week to be as thorough as possible. We should hear back whether or not Sam is approved for the ABA by the end of the week. If approved, we can set up services and get an in-home program going immediately, COVERED AT 100%!!! Considering these programs cost anywhere from $1000 – $3000/month, that is a HUGE victory! However, if we’re denied, more fight will follow in the appeals process.


I feel like a very tired mama bear protecting and fighting for her baby cub. I’m proud of the progress I made in one day, even though I have half the amount of hair I had when I made the first phone call. But, help is on the way! Meltdowns are still an issue for now, but at least there’s a glimmer of light at the end of this tunnel.


                        Post tenebras, LUX!