I said, "If Kaiser had a throat, I would punch it in it." I meant it. ; ) The hoops that they make you jump through just to get a denial letter, it is simply ridiculous. It's bad enough that they do not cover ANY therapies for children with Autism. None. Zero. (Unless you are one of the few who have the time and money to sue them and are lucky enough to win-I happen to have neither of those at the moment!). Even in those cases, think about all the time you're either still waiting for therapies, or going broke paying for them yourself. It's disgusting.
So this is what's going on, as of now. He was diagnosed on the 11th, we have that formal diagnosis. We meet with Alta Regional (Sac County's EI) on the 3rd. In order for them to cover some of the 25-40 HOURS a week of ABA (Applied Behavorial Analysis-something that has been proven to be effective in helping children/people with Autism) that he has been recommended to receive, we need denial letters from Kaiser stating that they will not cover any of his therapies. Kaiser knows they won't, we know they won't, Alta knows they won't ....yet of course we need the letters. Which is fine. We were told we had to do the following in order to get the denial-
A huge range of bloodwork (done on Friday)
A formal speech evaluation at Kaiser (done last Wednesday)
A formal OT evaluation at Kaiser (appointment is Monday the 29th)
At his speech eval last week, they found no physical causes for him to non verbal-which we knew, obviously. No cleft palate, etc. So she was very nice and said she'd type the report up that day and she knows OT will do it the same day as well, so we should be good to go with our denial letter by the 3rd. I mean, yay! you're not going to help him ...but at least they're telling us quickly, right?
Wrong. Last week, I get a letter from someone in member services, saying they've received our request for speech and want all of our outside speech paperwork. Um, okay. You mean the eval from Bright Starts, and the inital eval from Alta? Okay sure, we gave that to the ASD center on the 11th, but we'll send it to you too. Except that, big surprise, she never answers the phone and hasn't returned my (so far) 2 calls to let us know if this is in fact, what they want. They also were kind enough to put in the letter that it will be discussed at a "routine meeting" sometime in the future-no hint of WHEN, and that we'll receive notification of their determination within 15 days of THAT date. The date we don't know.
Fabulous. This all seems like such a huge waste of time, both our's, and more importantly, our son's! Their time and resources as well. The worst part is we already KNOW they cover no services. Us asking them to is simply a formality to get the damn denial letters.
I was so hopeful that he was going to be able to begin more therapies next month. That seems very unlikely now. The 45 minutes a week of speech he gets now is not going to cut it much longer.
Kaiser seriously can suck it most of the time. Did I mention that due to his sensory issues, brushing his teeth is akin to murdering him and he therefore has about a million and one cavities?? And of course you can not take him to a regular dentist or even a ped dentist because the only thing worse than brushing his teeth is taking him to any sort of medical office. ; ) I mean seriously ...if one day, out of the blue, you hear a bloodcurdling scream in the distance-it probably means Rocket is at one of his appointments! So the poor guy is going to be sedated, which Kaiser's Delta Dental does not cover??? I'm going to fight like hell to get them to cover it-I mean COME ON. He's not even two and a half and he has Autism, I'm not seeing a whole lot of other options outside of letting all his teeth rot ...and then what's next? ...our Christmas photo will have him all missing teeth and sporting dirty feet and a saggy diaper. It's a white trash Christmas, everybody! ; )
Financial stress is a sad understatement these days!
But on a happier note, speech went well today. It has been for a while, thank goodness. He and his guy are a good match, it's a routine for him now ...he walks right up and opens the doors and goes in. He has trouble leaving his favorite toy in the waiting area and going back into the therapy room, but last week he even held his guy's hand and walked back with him! So we're making progress ...maybe not actual verbal progress, but I'll take what I can get right now!
That's our day so far. Speech is good, Kaiser sucks ...that's about it. ; )
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