Thursday, December 3, 2009

Can You Feel The Power?

On Tuesdays, I take my son to his counseling appointment.  Well, at least on most Tuesdays.  He has been seeing this counselor since June of 2004.  I started taking him to her when he began banging his head against the wall hard enough to bloody his nose.  He usually attends once a week (usually on Tuesdays right after school) as long as she is available.

Since he has started counseling, the head banging and self biting episodes have become nearly non-existent.  It has helped with lots of other things too. me just quote the paragraph that is in his newest yearly treatment plan: "has demonstrated progress in his ability to accept criticism and/or correction, to develop social relationships appropriate to his developmental level, to display spontaneity and emotional and/or social reciprocity, and to express and understand humor.  Additionally, his display of self-abusive behaviors has greatly decreased.

So I guess that 5 and half years of weekly counseling has brought us a long way, huh?!  Of course, there are about two pages of things that we are working towards at this time, but we have still come a long way!

With all of that said, why would you want to stop taking your child to a place that has done so much good for him?  Well, I don't want to.  However...I am not the only one who makes these decisions.  I have held off the DNA Donor several times concerning this very thing.  You know how it is....too much time, costs too much, doesn't need it, yada yada yada.

Today, I am the one considering taking him out of therapy.  I know this is not a good thing to do, so maybe I should just switch counselors.  The problem with that (as every parent of an autistic child knows) is that he has 'bonded' with this counselor and has become quite comfortable in the environment that is provided each week.

So what has got me all in a tiz about possibly pulling him?  It all started last October.  Crazy Man got new insurance that covers all of us, The Boy included.  I told the girl at the front desk that The Boy now had a secondary insurance.  

*A little background info here: this is a one counselor office.  She did not have anyone who even sat at the front desk until her son got married to this girl. Once that occurred, this girl shows up in order to keep track of the appointments and payments and deal with insurance.*

When I told this girl that The Boy had a secondary insurance, she said "ok but his primary insurance is paying just fine, so we probably don't need to worry about sending it into his secondary."  

At the time, I was fine with that.  Once I began slowly coming to my senses and realized that if the secondary is billed, then that will go against his deductible, it was summer of this year.  I asked the girl if she would start to file those claims with both insurances and explained my reasoning.  

Let's just calmly say that she was not happy. After a couple of months, she told me that it was a pain and that if I wanted her to file the old claims, I would have to pay a fee of $8 or something like that so she could send them to the right place instead of the place she had been sending them.  I told her that I did not understand.  She said that my insurance has a different place that these mental health type claims go and that I should know that.  I told her that I did not know that, but I was not in charge of how insurance worked and all that went with it when sending in a claim.  I gave her the insurance card and can only read what it says and that it was her knowledge about insurance companies that I was relying on.

Needless to say, she wasn't happy again.  Well, neither was I if truth be told.  However, I gave her the money to have it refiled and went on my merry way.  I have yet to receive anything from my insurance company, but they are always slow and I have other things to worry/think about.

This past Tuesday, I took The Boy to his appointment.  He was in the midst of it and I was in the waiting area balancing my checkbook when the DNA Donor walked in.  This receptionist greets him (like she always has) with a bright cheery smile and a voice that goes up an octave compared to what she sounds like when talking to me.  DNA Donor gives her his check and doesn't even get to sit down before the counselor is out there telling him that we all need to come back and have a little meeting because "we have a problem."

I gather up all my stuff and walk into the little room where The Boy sits waiting.  I realize as I am sitting down at the table that not only is the counselor there (duh!) but so is her receptionist/daughter-in-law.

I have absolutely no idea what is going on here!  Her receptionist has a piece of paper laying face down on the table in front of her.  The counselor says that there are insurance problems and that "B" will explain them.  

"B" turns over the paper and says that she has received this explanation of benefits from the DNA Donor's health insurance denying the three claims she sent in for October.  She says that the insurance has written on this that the member must contact them with any information concerning a secondary insurance.  This includes who holds the secondary insurance, that person's name, address, phone numbers, social security number, and birthdate.  She tells us that until this is done, that all claims filed will be denied.  She then goes on to say that because these claims have been denied, they will have to be refiled and they have begun to charge $5 for each claim that is refiled.  So,  before the current denied claims are sent back through, we owe them $15.  

Once this has been spoken, "B" turns to me and says "you have three choices."  (How this had become all my problem at that point I wasn't sure!)  I was told that I could either give all of that information to the DNA Donor or I could have her stop filing with the secondary insurance or I could just pay the entire bill that had been denied by the insurance.

Taking a deep breath, I, as calmly as possible, told her that if she could give me a copy of the paper she was looking at that contained all the information being asked for and the phone number listed, I would be more than happy to call and get this done.  I told her that it was not my information that I would be giving, it was Crazy Man's and that his personal information is not legally mine to give.  I also told her that I seriously doubted that he would like me to just hand over that info to anyone.

"B" tells me that I have to give it to DNA Donor because he is the member and she would not give me a copy of the EOB.  I asked for the phone number then.  She again told me that the DNA Donor is the one who would have to have the information to take care of it.  

I told her that unless she gave me the phone number, we were at a standstill because there was no way that I was going to pay the whole bill when we had insurance that would take care of this, and since the primary insurance refuses to move ahead until information concerning the secondary is presented, she may as well not file with them either.

Again, "B" told me that I would have to give the information to DNA Donor.  I told her that I was legally allowed to take care of this because I order his prescription meds all of the time through this insurance.  She also told me that she had spent a lot of time filing these claims with both insurances and "your secondary insurance hasn't even paid anything." 

It hit me then as to why this was all my fault.  Evidently I have more power than I realized!  I am the one who controls how much an insurance company  pays and when they pay it!  Wow!  If I had known that I possessed this much power, I would have been finding a way to get a message to the President to let him know that if he is having trouble with insurance/health care, he should be talking to me because I have the power to change it all!  Amazing.  I think I am going to sell this service to folks that are having difficulty with their insurance companies.  Or at least the two companies that The Boy is covered under.

Becoming angry, I said that this was not totally my fault.  Yes, I would accept responsibility for asking her to send in the back claims for the year once I came to my senses and realized they could count toward my deductible.  I had paid my fine and that should be the end of that.  I would not take responsibility for the fact that the insurance isn't doing what she wants it to do.

The counselor looks at her and asks if there is a toll free number on the EOB.  When she was told that there was, the counselor told "B" to go make me a copy and she would set up a phone so that I could call and get this taken care of.  "B" stomped out of the room and I could then hear the copier.  

The counselor followed her out of the room and I hear "B" telling her that this was not her fault and this was not her job.  Once the copy was made, "B" comes back into the room and throws it on the table in front of me and then stomps out.

I go into the other room to call the insurance.  I tell them the problem and the lady asks who the secondary insurance is. I tell her and then she asks if I have a divorce decree that states that the DNA Donor is required to provide health insurance.  I tell her that I do.  She makes a note of that and says that she will resend these claims through and that their should not be a problem.  She tells me that the office does not have to do anything other than sit back and wait for a new EOB.  She says that I should also be on the look out for a new EOB.  When I explain to her that I have never seen an EOB from her company for my son, she tells me how I, as the biological child of a minor child, can receive the EOBs.

I thank her for her kindness and go back into the other room to let them know that everything is taken care of.  I tell them that nothing has to be refiled, so no charges should have to be paid.  I tell them that if the next EOB comes back as denied, to let me know and I will call them again to see about getting it taken care of.

I am told that if the charges are denied again, then I will owe them the full amount of what they had submitted which would also include the November charges, until the insurance issue was taken care of.  I laughed and said that there was no way that I would be able to take care of the complete cost of 7 visits by myself.  Again, I would accept my responsibility and do my best to pay my half, but the DNA Donor was going to have to step up and do his part too.  

Let me tell you.....I was ticked off.  However, not one time did I raise my voice nor did I cry like I usually do when I get so mad.  "B" stood there after I had taken care of all of this and tells me that she had been dealing with insurance issues all day and then she had to deal with me and she was just done.  None of this was her problem.  The counselor tells all of us "you have to understand that I provide a service here and "B" is hired to make sure that I am paid for that service."  

Really?!  Then how is this not her problem?  And, how is this not her job?  And, why did we have to use up my son's appointment time to take care of this situation?  Should this have not been taken care of at a different time?  How many times have you gone to a doctor's appointment and he invited the billing person into your visit with him to talk to you and hash out a payment plan?!

Yeah...I wish I had the power they all feel that I possess.

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