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For those of you following the insurance saga, we finally have some good news! After six months of compiling treatment plans, getting Ryan’s school authorized as a provider, sending reams of paperwork to Anthem, making endless phone calls to check on claims status (and figure out why the heck they keep “losing” my claim forms), the first claim check for Ryan’s ABA-based preschool program arrived today. Thank God! Hopefully, it will be smooth sailing on this front – or it could just be a fluke 
I can only hope that now a precedent has been set and things will be easier from this point forward, at least from a claims perspective. My younger son Alex will be starting in the same program in a matter of weeks, so we will have to repeat the whole authorization, treatment plan, etc., deal – but I am hoping we won’t have the same kind of ridiculousness. Now, on to our second appeal for additional occupational therapy coverage! It just never ends…
Didn’t get in a run tonight – the muscle in my leg that cramped up last night is still pretty stiff and sore, so I’m going to do plenty of stretching and maybe go for a short run tomorrow or over the weekend before starting to really pound the pavement next week.
The hardest part of training for these upcoming races, really, is trying to find a good running path around here. This area is so freaking hilly, it about kills me, and all the flatter roads have extremely steep slopes in the breakdown lanes where I run, so it’s just asking for trouble. No sidewalks anywhere (this is the country, after all) and not many options, but there are plenty of deer to keep me company!
Just came back from a 5 mile run and I’m fairly proud of myself. The first leg of the run, about 3.2 miles (or a 5K) is all through a neighborhood that is just one steep hill after another, but I finished that part in 31 minutes, or a full minute faster than the last 5K I ran in June. Not too shabby! Nice to know that my legs are still good and strong from boot camp. However, in the second part, which is just a mile up and back the (flat) main road, I started to feel a cramp start deep in my hamstring, so I ended up walking a good chunk of the last two miles, but still managed to finish a 5.2 mile run in about 56 minutes, so still pretty good for a novice runner like me.
Nothing new to report on the insurance front, which is good and bad and exasperating. Please keep your eyes peeled for ads that should be playing all over the country, funded by Autism Speaks – these ads urge everyone to contact their government officials in the House and the Senate and urge them to support federal insurance coverage for autism treatments as part of health care reform. For more information, or to send an email to your representatives, you can go to www.autismvotes.org and click on “Federal Initiatives”.
Gorgeous weather for running today – so out I went! Very cool for this time of year – only 67 degrees and cloudy, which means I didn’t need to wear sunglasses, which I hate anyway I upped my distance to 5.2 miles today, although I definitely won’t be doing today’s route again anytime soon. My husband warned me that going up Taylorsville Lake Road would be problematic since there are really steep grades on either side of the road and you’re basically running on a slant the whole way, but my stubborn self did it anyway! I started out really strong and did the first mile in a personal best of 8:30, was at 17 minutes at the 2 mile mark, then the hip pain set in and basically stayed with me the rest of the way. And did I mention the hills? Ugh. I managed to finish 5.2 miles in 56 minutes, but I had to do a lot of walking due to my old nemesis, my right hip. I think from now on, I’ll stick to the Hunt Country Estates route.
Less than a month to the Grand Slam 4 Miler downtown! If you’re planning to run or cheer, look for me in my spiffy teal and yellow Organization for Autism Research shirt! Over the next two weeks, I’m going to begin my fundraising push by asking for $4 donations before the 4 Miler – please visit my fundraising site at http://www.firstgiving.com/juliecraig2 to make a donation!
For those of you following my insurance drama here and on Facebook, there’s an update on the claims front. I’ve submitted three sets of the same claim forms for Ryan’s ABA therapy to Anthem over the past three months and the first two times, the forms just vanished into the ether. The last time I called about claims, I talked to a very nice rep who told me to fax the forms directly to her, she’d mark them as high priority and walk them down to be scanned and processed, and I should be able to log into Anthem.com by the end of the week and see that they’d been entered into the processing system. Imagine my shock when I dutifully logged in and checked the status on Friday to find – nothing! We went out of town for five days, and I checked again this morning when we got home and saw – nothing again! I called over to Anthem for the millionth time and asked what the hell is going on over there. The rep I talked to said that there was a note in my call records that said that the rep I had spoken with previously had indeed received my fax and had followed through and taken the forms down to be processed. The note also said that she was told that there is a special department just for processing ABA therapy claims and if the forms aren’t sent directly there, they basically get tossed in the round file.
ARE YOU EFFING KIDDING ME?????
I’ve been calling the company for FOUR MONTHS, have talked to probably every rep in the building by now, even called to verify that there wasn’t a special claims department that handled autism and behavioral health claims before I sent the first round of forms in, and no one bothers to tell me about the special claims department just for ABA therapy claims? Even once they find out about this, no one bothers to call me to tell me where to send the next round?
I didn’t say any of this to the poor guy who was just doing his job. I gritted my teeth and asked if he would be so kind as to share with me the address for the ABA claims department. He did, I thanked him, hung up, and slammed my head into the dining room table and then went and yelled at my husband for a bit. I can’t wait to put all of this drama into a letter and start sending it to governors, senators, representatives, oversight committees, better business bureaus and anyone else I can think of. And don’t think I’m not pissed off enough to do it
Got a call from the insurance company today – shocking! One of the first things they’ve said they’d do that they actually delivered on! Still waiting for claims to be scanned and processed – they were supposed to be done by today, but still aren’t in the system. Despite denying my appeal for additional OT benefits, once I informed them that refusing to cover needed autism treatments as recommended by both pediatrician and occupational therapist violated the Indiana state mandate, they have been reviewing my case, and the call I got was to let me know that they are still researching and trying to figure it out. I am choosing to think that this is a good thing – at least they’re not just blowing it off! If they choose to deny the appeal again, my next call will be to the Indiana Department of Insurance and possibly to an insurance/special needs children lawyer.
Training-wise, not much is happening. Set the alarm to get up early this morning for a run – was going to push the distance a little and the weather was supposed to be fairly cool, but an early-morning thunderstorm put the kibosh on that idea. Still having shoulder problems, so lifting or ab work is very difficult, but we’ll see what we can do. Will try again for tomorrow a.m. In the meantime, just working on keeping well-hydrated and keeping the diet lean and clean – easier than I thought it would be!
While I really don’t intend for this to become a blog about my trials and travails with the insurance company and the nitty-gritty of trying to provide appropriate and consistent intervention for two little boys on the autism spectrum, every now and then I’m going to have to vent. Like today.
For heaven’s sake, what good is a state mandate requiring coverage of autism treatments when no one is requiring the insurance companies to comply! The lack of education that almost every customer service rep (except one, so far) about the Indiana state mandate and the Kentucky state mini-mandate has shown whenever I call is shocking and disgusting. Anthem has managed to strategically lose my claim forms twice, despite the fact that I sent them certified mail with delivery confirmation the second time (so I know they’re somewhere in the building…), and lost my appeal package asking for weekly occupational therapy for Ryan once. Now, since none of our claims have been reimbursed yet, and our appeal was denied (illegally, in my opinion – see above reference to state mandate requiring coverage), we are staring down the barrel of $1500 per month just for Ryan’s therapies. When we add Alex’s ABA sessions in August, that number jumps to $2000 per month, and when he ages out of First Steps (Kentucky’s state-run Early Intervention Program) at 3 years old next February, we’re going to have to start paying out of pocket for additional ABA and OT sessions. Unless Anthem steps up and starts doing what the state has mandated they must.
The hellish part is that it is a generally accepted fact that our best chance of helping the boys to overcome the challenges that their autism presents is to bombard them with appropriate, constant and consistent treatment and therapy at an early age. We were fortunate enough to have caught them both at an extremely young age, and we have already seen for ourselves the power of early intervention. To me, if we need to scale back our treatment plans for them for budget reasons, it is almost a crime. Every missed session is a wasted opportunity; every lost hour could mean a lost year or lost mastery of a skill. Letting the kids stagnate while we argue with Anthem over insurance coverage, instead of getting them to ABA or to OT sessions is tantamount to neglect in my book, and if I get really pissed off, I just might sue Anthem for delay of care and negligence. Heck, if someone can win millions from Mickey D’s for serving hot coffee, I might have a case too.
This is why this run is so important to me and so is my fundraising/outreach efforts. The more research we can do into therapy and teaching tools and techniques, the longer the list gets of what insurance companies should cover. Keeping autism awareness top of mind as we push for better legislation, better enforcement of insurance laws, and broader coverage for our kids is a must. 1 in 150 kids, people. 1 in 70 boys. If you don’t know someone on the autism spectrum, you will soon. That’s how prevalent this is, and that’s why I should get off the computer and go train for the mini.
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Got the fundraising package from Run for Autism today – I’m so excited to be a part of this effort! Guess I really have to run the half-marathon now, huh? Hopefully I can get out for a run tonight or tomorrow night – we’ll be on vacation for a week starting on Saturday and I don’t see me having much time for a workout or a run.
Oh, and for anyone actually reading this keep your fingers crossed that the insurance company will actually come through and approve more occupational therapy benefits for Ryan. We’re allowed 20 visits per year and hit number 20 last week. It will SUCK if we can’t figure out a way to get more – at $110 an hour, we’d have to start selling organs or something to pay out of pocket.
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It is seriously too hot and disgusting outside. I should be headed out for a run, but the humidity is too much for me. Ugh. I’m going to try to do some arms and abs tonight instead – now that my pulled neck muscle has healed to about 90%, I’m ready to get back to it. Might have to start getting up extra early in the morning for a run – it’ll be me and the deer hitting the pavement around 6!
These races really have a way of getting to you – even though the heat and humidity made the Champions 4 Her 5K this past weekend a less than comfortable run, I can’t wait for the next one! Only six weeks to the 4 miler…
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Got up in the ridiculous heat this morning and ran the Champions 4 Her 5K downtown. Great event, lots of people, but man, was it hot. It was ok until we came over the bridge and turned onto Main Street, and the heat and humidity were really overwhelming. Managed to run the whole way, and improved my 5K time from six weeks ago by almost 9 minutes, so I was pretty excited about that. I ran as part of the Mohr Results team and running with a team is definitely the way to go! It was a huge boost to see all the pink shirts out there and see other runners giving you high fives or thumbs up as we went past them.
So, the next race on the agenda is the Grand Slam 4 Miler at Slugger Field on August 1st. After that, I’ll do the 15K in the Downtown Doubler in September, and then run the Louisville Half Marathon in October. Should all be good prep for Vegas, especially if I can get in another session or two of boot camp to help keep the legs and core strong.
Biggest disappointment of the day – the brand-new (as in just out of the box new) Skullcap earphones I bought to use on the race sucked major ass. Bad wire on one side, crappy bass and volume, really not good at all. They stayed put without me clamping my hat over them, which is more than I can say for the cheap earphones I got from Wal-Mart, but the sound and functioning were pitiful. Hopefully Dick’s will take them back!
Filed under: Uncategorized | Tags: autism, beginner, fundraising, marathon, run for autism, running
So, the past few weeks have seen me doing two things that I had sworn I would never do (and didn’t really see any need to do, actually!): run a half-marathon and start a blog. I have to, once again, blame the good folks at Mohr Results Adventure Boot Camp for turning this couch potato into something resembling a running junkie. I discovered during one of their sessions that I didn’t actually hate running after all, and that I could actually come to like it. Gasp! I completed my first 5K in early May and when I realized that I had run the whole thing without collapsing or dying, I was hooked. My husband, the Running Fanatic (or Fool, we’ll just call him RF), pestered me for a few weeks until I finally relented and agreed to go to Vegas with him in December and run the half marathon while he ran the full marathon. I’ve got a bunch of 5Ks and slightly longer races coming up over the next five months while I train, and I wanted a record of the process, hence, blog.
Never thought I would ever need one of these newfangled contraption bloggy things, I leave that to my brother (you can check out his blog, if Connecticut politics is your thing http://ctlocalpolitics.net/). But thanks to the magic of Facebook, I have managed to convince myself that maybe my endless rambling really is interesting to some people! Who knew…
Lastly, I will say that I decided to make this race in Vegas really count. I also want to lock myself into so completely that there’s no way I can back out without looking like a total douchebag. I have joined the Organization for Autism Research’s Run for Autism team for the Vegas marathon. I have two very personal reasons for wanting to give meaning to the run and raise money for applied research – their names are Ryan and Alex and they are cute and mine.
More later. Please visit my fundraising page at http://www.firstgiving.com/juliecraig2 to learn more about the race and OAR’s mission.
