adhd · asd · aspergers · aspie · autism · christianity · effective communication · God's Promises · insurance · mental health · praying · PRTF · residential placement · special needs

I Didn’t Win The Lottery: Part 1

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Earlier this week, I wrote this post. I was devastated that the state insurance that is currently paying for our son’s PRTF was demanding that we move him to another facility. Based on all available information, we could not determine exactly what the basis of their decision was. We begged for information and no one could (or would) share any information with us. So, with that, I set out on my own mission. 

I am his mother. I know him better than anyone except Daddy and God. I feel this is the best place for him and I will not stop until I have exhausted all efforts. 

We had a meeting with the insurance representatives and his treatment team. The treatment team agreed that due to his issues related to the diagnosis of Asperger’s, it would be detrimental, if not cause irreversible regression should he be moved. The insurance representatives agreed that this is the case. Despite the doctor and therapist requesting for them to change their decision and allow him to stay, they denied the request. Finally, they told the treatment team and us that we really had no choice, so we needed to move forward with other options. 
Mother love is the fuel that enables a normal human being to do the impossible.  ~Marion C. Garretty, quoted in A Little Spoonful of Chicken Soup for the Mother’s Soul

And, with that, I made the decision to contact the CEO of the facility. I figured I would bring a proposal to the table and all he could say is “no”, right? I prayed about it, in fact, I begged God to give me the right words and strength. I mean, calling a CEO of a company that holds the life of my child in his hands is big stuff, ya know? I picked up the phone, and I called. I had to leave a message and my balloon deflated. I honestly did not think he would call me back. He has all sorts of other important people and things to take care of, why would he?

Within a few minutes my phone was ringing. I answered and he wanted to know just what could he do to help me. I took a deep breath and I told him. I told him exactly what it was he could do to help me. He could take my private insurance and understand that I have no way of paying the copays and deductible, he could let my son stay there, and he could ensure he continues to receive what I feel is the best possible care. Yep, that’s it. Nothing major, just wave tens of thousands of dollars in out of pocket cost, let my kid stay for that huge discount, and make sure he receives the same level of care. Thank you very much!

He replied with, “Put that in writing, email it to me, and I’ll take it to our CFO and we’ll see what he can do.” 

OH.MY.GOSH!? Did he really just tell me he’d try? You mean, that was not a “Nope, sorry, you are out of luck!” Really, he said he’d try!! (insert lots of praises to God, screams of happiness, and phone calls saying OMGOSH HE DID NOT SAY NO!)

So, I did. I wrote this email. 

Dear Sir,

Per our phone conversation earlier, I am sending this email to discuss the care my son is receiving at (his current PRTF) specifically. 
He is a 9 year old boy with a tentative diagnosis of Asperger’s. He does have a possible co-morbid diagnosis of ADHD and is currently being followed by Dr. Game and Awesome Therapist. He is a complex little boy who is difficult to form a relationship with due to the nature of his diagnosis. He is also unable to adjust to new surroundings and new care providers easily. If the initial meeting with him is not positive, he shuts down and will not open himself to treatment with those individuals. 
At this time, he has formed a very strong personal and therapeutic bond with Awesome Therapist. He is making great progress in his treatments. In fact, the progress that he has made in the 30 days with (current PRTF) is the most progress I have seen in him ever. His communication with family has improved exponentially. His communication with therapists, doctors, and peers has also improved. In addition, he has also grown in other areas of his treatment. He is learning to control his anger, to ask for a safe place in order to prevent himself from losing control. He has started working on learning the differences between his own feelings, as well as how to discern the differences in the feelings of those around him. He has never been able to do these things with any of the other therapists or professionals that have worked with him. 
We believe that it would be detrimental to his treatment success, but more importantly his lifelong success to remove him from (current PRTF) and the care of Awesome Therapist and Dr. Game. My understanding, during our treatment team meeting with (current insurance company) yesterday, is that they feel the same way. Both mentioned to (current insurance company) that any changes would be AMA, as well as against clinical advice. 
With this in mind, we have an option that we would like for you to consider. While he is currently on (current insurance company), in order to keep him at (current PRTF) we would move him back to our (private) insurance through my husband’s employer. However, we are unable to afford the cost of copays and deductibles for his treatment with (current PRTF). Would you and your colleagues consider working with us to negate or significantly decrease the cost? 
We would like to thank you for your time and consideration in helping us to help continue what we feel is the best possible care for our son. 

Sincerely In Christ,
Mother That Does Not Stop


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