Saturday, February 12, 2011

Under Coverage

To begin therapy, first I had to find a good therapist. I got recommendations from trusted sources. I met with those recommended. I wanted to find someone I liked, that I felt I could trust, who would not just talk but would actively help us find solutions and strategies. Samantha was the clear choice. The only problem was, she didn't take insurance. (Many of the most highly recommended therapists do not, why is that?)

The solution seemed clear at the time. My husband and I would buy into the most expensive insurance plan (an increase of $100/mo) his company offeered. This would allow us out-of-network coverage. At $2,000, the deductible seemed substantial, but considering the fees we were paying and the frequency of his visits, we expected to meet it in no time. The sessions started off with immediate progress and it very quickly seemed we had found the best possible solution for assistance with our son and that the increased expenses we were paying for a better plan would be worth every cent. We forged ahead and looked forward to the day the reimbursements would start coming in.

When the first insurance statement arrived, we were shocked to learn the insurance company would not recognize the full fees but that they only recognize a third of it. And so only a fraction of the actual amount we paid would be applied towards our deductible. The same was true of the costs of his social skills group. And then when it became clear that our daughter was struggling and we wanted her to meet for therapy too, we then realized that our deductible was per patient, not for the entire family. As a result, it seems quite probable our deductibles will never be met.

And so, despite new laws requiring autism coverage in CT and despite the premium rates we're paying for a premium plan, for the past 6 months, we've paid for his individual therapies and his social skills class entirely out of pocket.

Silver Lining: I am truly convinced I found the best possible therapist for my children. Just today, I spoke to another Mom who started taking her child to one of the same network doctors I met and at about the same time. Unfortunately, she feels they've made too little progress and is now considering finding a new therapist. I feel I've gotten a return on my investment. I just don't know how we're be able to continue to afford such premium coverage with an ever out of reach reimbursement policy.

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