One Day to the Next

From Wednesday to Thursday, my world, in terms of feelings, went topsy turvy.

Wednesday
Overall, Wednesday was a terrible day.

Firstly, I contacted a local brand new ABA Therapy center to talk with someone about possibly enrolling Evelio in services when he is discharged. The owner called me back and asked for my e-mail so that I could fill out preliminary paperwork. At the end of the phone call, she asked me if I had any other questions at that time. I then asked if she would be accepting SoonerCare Insurance (Oklahoma Medicaid). Her answer was that unfortunately, most insurance companies were not covering ABA therapies at this time and especially not medicaid. That most likely, I would have to wait until the health insurance reform bill goes through. BIG LET DOWN. However, I explained that SoonerCare was covering the ABA therapy that Evelio is receiving at his residential school and that SoonerCare had to pay much more money to them than they would be responsible for if the center was local and there would be no live-in costs. She then said she would do some more looking around for me and then let me know, and until then I could look at the paperwork. This paperwork has the prices charged on it. OMG! It is ridiculously expensive. Now, I am not blaming the ABA therapist who set the prices. Anywhere you go for ABA, the price of it is extremely high. I became very depressed because if SoonerCare refuses to cover it, there is absolutely NO WAY I can afford this for my son. I'm talking $60/hr expensive. It got me thinking of how you really have to be rich in order to afford quality and necessary intervention services and therapies for your child(ren).

On top of that, around 5:00 pm I get a call from the business management/billing office of the residential school that Evelio attends. She says that their records are showing a discrepancy during the month of June where his SoonerCare was inactive for 12 days. I explained that SoonerCare had sent a recertification letter to me during the month of May and I chose to do this over the Internet. I did the application online again and it said that he was approved again. About a week later, a letter came in the mail saying that he was covered and who his primary care physician was. Then, a few days later, another letter came that said he was NOT covered. So, I re-applied online again and again it said he was covered. The same letter came confirming coverage, and then the letter declaring non-coverage came. I finally called our local Department of Human Services and they said that since my son has a disability, I would have to apply in-office. So I did. At my interview appointment, the worker told me that online, as soon as I entered the information that my son receives SSI/Disability or put in that he has a mental disability, a message should have popped up and told me to go to my local office. I explained that it didn't either time that I applied online. Anyway she ended up saying that I was covered. When I reported back to my son's therapist I was informed that the situation was taken care of and he was covered. Then she informed me that she had been under the impression that it had been taken care of as well, however she had just been contacted by SoonerCare with a message that the rules had changed and they would not backpay any previous medical charges while the insurance showed as inactive. "So what does this mean?" I asked. And what she said made me drop my phone and my heart stop. "You will be receiving a bill for approximately $7000 in the mail." I felt like I was going to pass out. All I could do was cry. Sure, I can make payments, however THIS IS NOT FAIR and I'll end up paying this for the rest of my life.

However, Thursday got a little better.

I had been sad all day thinking about the things that happened on Wednesday. I called Evelio's therapist and talked to her about that HORRENDOUS bill. She advised me to call SoonerCare and get this straightened out and also gave me another name and number of someone that could help me better with the situation than she could. Then I started talking about my plans for Evelio to come home sooner than they had planned and how I was scared to pull him out against medical advice, because what if SoonerCare refuses to pay for the entire 4 months that he's been up there if I take him out against the doctor's advice. She stopped me in the middle of my random, ranting worries. She told me that she had spoken with Evelio's doctor and that the doctor had a plan. She said that if I take Evelio on a 2-day home pass on Monday (so that he would be back at school on Wednesday) and he behaves and is good, that he will be allowed to discharge on SEPTEMBER 26th!!! That's 2 days before his birthday. I felt like I was going to cry then too. But out of joy. I am so glad that this news came today because it's just what I needed. So now I have something to look forward to. I am super excited to finally have my baby back home after a very long time apart. He has made a lot of progress with self-help skills and therapy tasks, and is now able to use the potty with almost no accidents. That news washed away all my despair that was brought on by the monster of Wednesday. Although Wednesday was a terrible nightmare, Thursday totally changed the way I feel.

It got better from one day to the next.