Monday, March 23, 2009

billing code 96111

Why will nobody cover this billing code? Early Intervention doesn't want to cover an OT evaluation for Jupiter because they say her sensory issues don't affect her in the classroom. How do they know if they don't do the evaluation? They know, and actually wrote down in Jupiter's screening summary: JUPITER IS HAVING DIFFICULTY ACCESSING HER REGULAR EDUCATION CLASSROOM.

I guess I shouldn't be surprised. It took 3 forays into the world of Early Intervention to get JUPITER IS HAVING DIFFICULTY ACCESSING HER REGULAR CLASSROOM. Not all of her classroom issues are sensory. They are emotional, social, and developmental. And also sensory. And silly me, I just think that it doesn't make sense to work with the other three, and not the sensory. If her sensory is out of whack, so is the rest of her. Trust me. I live with her. I know.

But stick a developmental label on anything, and try to get the insurance to cough up. At least they put me on hold before they came back on the line and told me that they didn't cover developmental.

I had a nice conversation with the OT office today when I was signing Jupiter up for Sensorimotor fun summer camp that I read about in one of our local papers. I told them about Jupiter's need to rock and hit her head on the back of the couch or seat of the car, crash into things, jump on the trampoline for long periods of time, and about Brickle. Brickle is a brick she found in my parents yard last year and which she carried around all summer, drove around in her bike basket, pulled in her wagon, and pushed on the tire swing. The OT receptionist was impressed with her resourcefulness. Then we discussed getting the OT evaluation which Early Intervention/CDS doesn't want to pay for and which insurance also doesn't want to pay for, but which I think she needs and would benefit her. And oh, might even help her have fewer difficulties accessing her regular classroom.

AAARRRGH. I hate insurance. Once in November, 2004, I was in a children's clinic in Ekaterinburg with Jupiter, another baby named Eli, the orphanage director and another orphange worker named Nadia, my sister, and our translator. We were there for three hours so the babies could have blood drawn for a PCR test, an immunologist appointment, and another appointment I don't remember the purpose of. I swore then I would never complain about HMO's again.

I Lied. Oh how did I lie when I said that. How DARE the insurance people tell us what we need or don't need. How DARE they override DOCTORS in their medical decisions for their patients. And don't tell me the insurance companies aren't making a profit. Someone is taking the chunk of change I give them every pay period.

And then a couple weeks ago I heard how some politicians weren't going to support health care reform because it could put the insurance companies out of business.

oh, i have SO much sympathy for the insurance companies. Can't you just hear how I feel for them.

I might feel bad for people who lost their jobs if the insurance companies went out. But that's it. I just want a system where people can get the health care they need. And comprehensive health care. None of this not covering procedures because it's developmental.

I'm surprised some insurance company isn't getting lists of birth certificates and selling developmental health insurance to families with newborns, actually. Maybe they are and I missed it.

Anyway, rant over. I'm doing research and figuring out who I can get in our corner when I fight with CDS ( I mean advocate for my child, of course) about what Jupiter needs. I did lots of that today in between fighting with the MP3 from HELL.

Now I still have to go clean up the cat puke off the rug. Hairballs.


Torina said...

Obtaining proper healthcare for my kids is the bain of my existence. I feel for you.

Lisa said...

It is unbelievably hard. I am so sorry....

Keep the fight!