Insurance. Enough said. I could stop there and you would all understand.

I had a rather unusual experience with our insurance carrier last week and it has taken a solid week to digest. Sam was born during a time that I worked with a large technology company that employed more than 110,000 people worldwide. The insurance carrier was CIGNA and we were on a PPO. Since Sam was born premature (7 weeks early) and Angie had Preeclampsia, we saw the entire gamut at the hospital. Every nook and granny was shown to us and we never imagined (at the time) that we would end up receiving services from every single department they showed us. From the surgery, NICU, Special Care Nursery, after care, developmental pediatricians, the list goes on and on...we racked up hundreds of thousands of dollars in charges. Fortunately, our insurance plan made a significant dent in the overall bill and we were thankful.

Fast forward a few years and we learn quickly that insurance and the challenges that Autism bring forth don't mix. I changed employers and remained in a position of influence to direct our carrier choice. CIGNA was still the prominent carrier and being with another large tech firm didn't hurt. There is power in numbers when it comes to insurance. The reality is, the majority of the United States citizens are employed by small to medium businesses. You often hear in the news about the large power-house, massive employers and their insurance issues. There are so many problems with insurance in the small to medium business sector that the news can't even keep up. Our company Plan Document (when your company is self-insured the Plan Document is the black and white of everything your employer is going to cover under their health and welfare benefits plan) was not accepting of many of the issues families with Autism, Speech Language Disorders, Child Phsychology, Child Psychiatry, Nutrtion Planning, or many of the other services we are faced with selecting from. Within a year, our health and welfare plan went through some changes at the Plan Document level and services that once were not covered became covered. The good old days.

After creating three companies, I have seen the uglier side of insurance from the small business side. From day one, we made it our single priority to invest our money into the therapies, interventions, social skills, medications, and supports that will help Sam to lead a healthy and productive life, whatever that may look like. Our second largest contribution and investment has been into building AutismSpot, SpotUniversity, and all of the health and educational businesses within projectLD. I have always had a high respect for people that put action behind what they say. I couldn't look in the mirror if I wasn't willing to do the same with my time, effort, and money. When I see companies and organizations that practice what they preach and make honest, concerned efforts to do the right thing it brings me joy. I promote and share those businesses and organizations with my entire network. From the center of hubs, outliers, "influencers", you name it...the entire network gets an ear full.

Two years ago we selected United Healthcare as our carrier choice. As a small business, we carried no weight or pull in negotiating our plan. The services may be limited (the entire first year none of Sam's care and services were covered but persistence paid off) but timely communication and staying positive throughout the entire process paid off in one particular area. Sam receives regular Occupational Therapy from two different therapists. One OT is clinic based and they work on things that require a large gym environment. The second OT comes to our home and puts Sam through a battery of obstacle courses to interactive metronome. We received a letter in the mail from United Healthcare letting us know that we had reached our maximum number of allotted OT visits for the year back in April. Twenty visits is all we get...so long farewell, we met our deductible but no services would be covered anymore. Then, last week, we receive a second letter from United Healthcare informing us that after reviewing the documents submitted by our OT, they would grant additional coverage for more visits throughout the year.

STOP! PAUSE! STOP! PAUSE!

Yes, you heard that right....without us lifting a finger or pressing buttons of any kind...the carrier made the right choice based on the information they were given. There was no battle, no mini-war on the insurance front. The carrier was communicated to in a clear and concise manner by the therapist in the documents she wrote for us, the ops manager (Amber) submitted the documents to the carrier in a timely manner and the system actually worked.

Joy!

A company that said they would do the right thing when presented the correct information.

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* I will save you from sending me piles of emails right now....the answer to your question is, "No. I don't believe that our health and welfare plans are adequate in the United States. I believe the government and large carriers have all of us in a terrible situation and little is being done to fix it. Regardless of politics, there has been and continues to be very little change when it comes to coverage for those on the Autism Spectrum. Until we break the cycle of control that carriers have over our medical options we will not see improvement for those with special needs or disabilities. This blog is intended to shed some light on the realities that; if you do what your carrier requests, if you stay positive in your dealings with the carrier and don't scream at everyone you speak with, sometimes you get a chance to see the right thing occur. Don't be surprised to see (in a few weeks) a blog discussing the trials and problems we have experienced....that would be too easy to write about and the list is long."