I am shaking and teary, but it’s because I’m so HAPPY. Since the last post, we did have another ABA implementer.. but only for about a month before she too had to move on. Also, our insurance provider changed at the beginning of the year. This meant that I had no clue to what extent any of his services would be covered, if at all. I did know that the company we were going through for his ABA was not in-network for the new insurance, and the same with his OT.
I have since found that there are in-network OTs and also Speech Pathologists in the area. (The old insurance would cover just one – the clinic at the hospital.) We do like his current OT, and they’re willing to work with us on payment, but in-network would have no deductible. That might be too good to resist switching, even if it means a period of the new OT getting used to him (and the uncertainty of whether they’d be a good mesh.) I’m weighing the options there. Speech, since he doesn’t currently have one, obviously we’ll just pick one of the in-network folks and hope for the best fit. He’s a lot more sociable/open to any people than he used to be a couple years ago, so I’m not as worried about that as I would have been. Having secondary speech beyond just what he gets at school will be wonderful for him.
That’s not the good bit though. I mean, the fact that there’s in network options now is good, but it’s still the fairly standard $30 copay/max 20 sessions covered per year. (And speech he would be best served going weekly, but we’ll take what we can get.. better than the none he’s getting right now.)
The fantastic bit is this – I had sent an e-mail to one of the newer ABA companies in town. Their website listed our new insurance as one of the plans they were contracted with, so I e-mailed with our specific info just to be certain that our plan was one that would cover it. I just got a call back from the gal in the KC office… not only is it a covered service, but it’s covered at 100%, no deductible. I made her repeat it… 100%. No copays? No copays. No co-insurance? No. It sounds like it’s free for him, up to age 19, as long as he’s got the diagnosis/prescription for ABA. Well I’ll be. We’ve got the diagnosis, and an evaluation form stating that they “recommend” ABA/EIBI for him. If they want it written on a prescription pad paper, I’ll get right on calling his doctors about that. *hehe* I’m so giddy.. not worrying about where the money for so many hours of therapy will come from? This totally makes the increased insurance premiums worth it. Times 10. (Pretty much literally, if I’ve mathed it out right. 😉 ) Also, if I’m remembering correctly from the time I talked to them last year before they were officially up and running in our area, this company employs their own implementers. This means that if one of them quit/had to move on, WE wouldn’t be the ones scrambling to find a replacement (which is what has lost us essentially two months here recently.)
And, for some non-money/non-therapy good news.. he is finally showing some vested interest in the potty. Probably thanks in large part to the Wintogreen Lifesavers he gets when he pees. *hehe* But really, we’re down to about 1-2 diapers a day because he’ll peel it off still dry and run to the bathroom and pee. Obviously not something you could do out in public where stripping half-naked at a moment’s notice is frowned upon, and there has been no #2 in the potty yet, but as a work in progress, I’ll definitely take it.