In Illinois, a law was enacted two years ago that requires health insurance companies to provide coverage for the treatment of autism spectrum disorders. When the law was passed, it gave hope to many families that insurance would cover more of the therapy that so many of our kids need. But, from my perspective, the reality is that insurance companies are looking even harder for ways to get out of their obligations.
In our most recent case, my son’s insurance company recently stopped covering his occupational therapy (OT) after paying for a couple of years. The reason, they said, is that the therapy was considered maintenance and not restorative, which means that they are saying that my son was not showing progress as a result of his therapy so they were not going to continue paying for it.
As he was actually making progress, we appealed the decision and submitted reports from his occupational therapist that showed how he had improved in every area of focus in his therapy. I figured that it was a no-brainer and that we would win the appeal. My wife, who is usually the one to deal with the insurance company, was skeptical.
She was right.
Yesterday, we got the letter which stated that they will not overturn the previous decision to deny coverage. This time, however, they gave a different reason. They said that the therapy was “not proven to be effective based on the peer review publications available.”
I’m going to have to do more research to find out what type of evidence there is that “proves” that this therapy is effective. But, I can already tell you that occupational therapy is common among kids with autism. And, regardless of whether or not there are studies that show how effective OT is with other kids, the truth is that my son has improved in all areas his therapist is working on with him. That alone should be enough.
The Illinois law says that “treatment for autism spectrum disorders shall include the following care… for an individual diagnosed with autism spectrum disorder…therapeutic care, including behavioral, speech, occupational, and physical therapies that provide treatment in the following areas:… (v) motor planning, and (vi) sensory processing.”
Under those criteria, my son's therapy definitely qualifies. Is it too much to ask that the insurance company comply with the law?
Living with autism can be hard enough sometimes. Having to constantly battle insurance companies adds unnecessary stress.
Enough already. Let my son have the therapy he needs.
Showing posts with label occupational therapy. Show all posts
Showing posts with label occupational therapy. Show all posts
Friday, November 5, 2010
Wednesday, August 25, 2010
Riding a Bike a Different Rite of Passage
Learning to ride a bicycle seems like a mini rite of passage for many kids. Along with becoming more mobile, it usually leads to a greater degree of independence. It is a rite that my six year old son has not yet taken, though certainly not for lack of trying on our part.
When Kai was a toddler, he never got enjoyment from riding a tricycle. While other kids pedaled as fast as their little legs can go, Kai hardly moved whenever we placed him on his trike.
When he turned four, we got him his first bicycle. It was shiny and blue and had a Thomas the Tank Engine picture on it. He never wanted to ride it.
When he turned five, my wife thought that a new bike would get him more excited about riding. Perhaps he needed one that was slightly bigger, and more comfortable for his growing body. We got one that was shiny and red and did not have any silly pictures on it. He never wanted to ride that one either.
We tried hard to get him to ride. One time, using his love of numbers as motivation, we created a series of small flags, each with a different number on them, and lined them up on the path at a nearby park. The idea was that I would run alongside Kai, helping him as needed while he would be pedaling hard and excited about making it to each subsequent number. My wife would be at the finish line, waving the final flag, and yelling encouragement.
While Kai loved the numbers, he showed no inclination to pedal on his own and I was mostly pushing him the entire way. After several attempts, I was out of gas.
Eventually, we accepted that riding a bike was not his thing. We came to understand that issues with his vestibular system impair his spatial orientation. He does not know where his body is in relation to the space around him, and that, in turn, makes movement difficult for him. He is easily scared when he does not have his feet on the ground. For that same reason, he doesn’t like to ride on swings.
This summer, we did not get a new bike. We haven’t created number flags. He hasn’t been on his bike once.
Until Monday.
His new OT has been working with him on movement. He’s been doing better at swinging on a rope when he is with her. She got him to promise to try to ride his bike once before his next session with her. When he came home that day, he asked me to get his bike out.
He got on and rode around the block. Yesterday, he wanted to ride again. He rode a little farther.
He still has his training wheels on his bicycle. He rides very slowly. I’m not sure if he will ever ride the way most kids do.
But, that’s okay. It’s just nice to see that he is overcoming his fears and is beginning to have better spatial awareness.
That is what I consider a rite of passage.
When Kai was a toddler, he never got enjoyment from riding a tricycle. While other kids pedaled as fast as their little legs can go, Kai hardly moved whenever we placed him on his trike.
When he turned four, we got him his first bicycle. It was shiny and blue and had a Thomas the Tank Engine picture on it. He never wanted to ride it.
When he turned five, my wife thought that a new bike would get him more excited about riding. Perhaps he needed one that was slightly bigger, and more comfortable for his growing body. We got one that was shiny and red and did not have any silly pictures on it. He never wanted to ride that one either.
We tried hard to get him to ride. One time, using his love of numbers as motivation, we created a series of small flags, each with a different number on them, and lined them up on the path at a nearby park. The idea was that I would run alongside Kai, helping him as needed while he would be pedaling hard and excited about making it to each subsequent number. My wife would be at the finish line, waving the final flag, and yelling encouragement.
While Kai loved the numbers, he showed no inclination to pedal on his own and I was mostly pushing him the entire way. After several attempts, I was out of gas.
Eventually, we accepted that riding a bike was not his thing. We came to understand that issues with his vestibular system impair his spatial orientation. He does not know where his body is in relation to the space around him, and that, in turn, makes movement difficult for him. He is easily scared when he does not have his feet on the ground. For that same reason, he doesn’t like to ride on swings.
This summer, we did not get a new bike. We haven’t created number flags. He hasn’t been on his bike once.
Until Monday.
His new OT has been working with him on movement. He’s been doing better at swinging on a rope when he is with her. She got him to promise to try to ride his bike once before his next session with her. When he came home that day, he asked me to get his bike out.
He got on and rode around the block. Yesterday, he wanted to ride again. He rode a little farther.
He still has his training wheels on his bicycle. He rides very slowly. I’m not sure if he will ever ride the way most kids do.
But, that’s okay. It’s just nice to see that he is overcoming his fears and is beginning to have better spatial awareness.
That is what I consider a rite of passage.
Subscribe to:
Posts (Atom)
