With all the facts in place, I have to admit that there is a slim chance we will be reimbursed. They have set so many road blocks. Each turn I took, they had meticulously laid a foundation that breeds failure for coverage. There was nothing that we could've done, not a referral, nothing, not one single thing that would have lead us to receiving coverage for ABA. Every path lead to the following roadblocks...
-No coverage for out of network mental health provider, referral or not. Has anyone found an in network ABA Therapist?
-Even if Gabe's school agreed to work with us and become an in network provider to work with BCBS's separate company (our great plan *sneer*, hands over all mental health claims and services to another company) it could take a year before they are considered in network, long after our claim has expired for reimbursement.
-Let's just say for agruement that hell froze over and BCBS reimbursed us for Gabe's ABA Therapy....The maximum we would get from our plan would be $2,000 per year out of the $24,000 that we have already spent this year alone.
- I found out who the mysterious case manager is....It's BCBS's solution to not having to deal with Mental Health Care. It is a company rather, that would work with the mysteriously unavailable in network provider that delivers ABA therapy services at a sweat shop pay rate. Where are those people?
-So, I thought I would then send Gabe to an in network psychologist that would refer him to an out of network psychologist (His current ABA therapist) and then happily receive my long over due rate of 90% unlimited services due to medical necessity and a happy stamp on my beautiful referral. Nope. My Mental Health Care Plan does not accept referrals for out of network doctors according to the service rep. The language in the contract is vague at best.
-BCBS.....You are sneaky. Those execs must be paid very well. How do they sleep at night knowing what they know?
That is to name only a few of the sordid tidbits left for us to pull our hair out on.
Where do we go from here?
- New plan.....New focus - Can't say what...but it's juicy. Will it work..not sure, but it's worth a try
- What's funny..not so much in a "HaHa" way, but more in the pinch the cheek and say sweetly, "You're so silly BCBS!" As parents, we will invest all we have in our children, no matter the cost or time. This whole appeal doesn't put me out, it's such a small thing on my to do list, but it's there and my child matters. That's where they fail....our love and dedication will surpass their need to draw out appeals, send irritating letters, because in the end I still have the drive to do what's best for my child and they will have even more parents like me cramming their faxes with paperwork. So there....
- I know I am right. Everything I believe about what I am doing is right. I don't need an insurance company to validate what I already know is valid. I have already won.
Just a few thoughts for today....
