Friday, January 23, 2009

VICTORY!!!!!!!!!!!!!!!!!!!!!!!!!!!



My beautiful friend Tara blogged about her "Word-for-the-Year" a few weeks back. This word is to be sort of your "Focus" for the year. I told Tara that my word for the year was going to be "FIGHT".  It seems to be all I do anymore with regard to Mason's Autism.

Fight - noun; a battle or combat.

We have been trying to get Mason some MUCH needed speech therapy for nearly a year now. Our insurance company (Cigna) has continually denied benefits. We have taken it to State level arguing that a Colorado state mandate rules that Autistic children under the age of five are legally entitled to speech therapy (up to 60 visits per year). Come to find out, OUR policy isn't subject to state mandates because of the way they are contracted with Gregg's employer. Well, back in Sept. I went to Gregg's employer (Big Ol' Hospital) and told them that their policy is not in state compliance and that my son is suffering for it. They agreed to change their policy beginning in 2009 so that Mason could get the speech therapy  he needs. We thought that was fair and went ahead and footed the extraordinary bill for therapy from Sept - Dec.  The first of January we put through the referrals for Mason to get speech therapy using this "new plan". We were DENIED stating the same reasons as before. Our plan had in fact NOT changed! I was unbelievably PISSED OFF at having been lied to by my husband's employers. I called said Big Hospital Employer and left a "Mommy Freak-Out" message on the head honcho's voice mail. At that point, I didn't care if Gregg got in trouble or faced reprocussions  for my tyrade. They LIED to me and my son was going to suffer even LONGER for it!

Well, today I got a phone call from a big-wig at Cigna stating that our insurance policy has been changed and that Mason will be covered not ONLY for UNLIMITED visits of speech therapy but for ANY AND ALL AUTISM RELATED TREATMENTS!!!!!!!!!!!!!!  This is unheard of in the state of Colorado. No insurance company in Colorado (to my knowledge) covers any autism related treatment because it's EXPENSIVE and you need a LOT of it. Some states require coverage for autism treatments, Colorado is not one of them.

The woman (big wig at the insurance company) told me that if ANYONE gave me any grief at all over billing, or benefits for ANY autism related treatments that I should call her directly and SHE would take care of it personally."Mason WILL be taken care of," she told me.  She was so sweet, and so understanding and she was my saviour today. THANK YOU DORRIS!

This is the biggest, hugest most mind blowing "WIN" I could have imagined! I was fighting to get him speech therapy and we got him total autism coverage! We got him what THOUSANDS of children in this area and hundreds of thousands throughout the country are being denied. We can now get mason the help he needs, and the insurance is going to pay for it! (Well, most of it anyway!)

I have been floating on cloud nine all day, you could not possibly wipe this smile off of my face. A weight has been lifted and now I know that I AM doing all I possibly can for Mason and it feels DAMN GOOD!


Thanks for letting a proud mom gloat!




12 comments:

phamil said...

YEAH!!!!!!! I have chills and tears reading that! I'm so happy for you all, I know that is such a weight off you and such a relief. I'm so proud for you! You so deserve this help, you are the best Mom!!!! Hugs to you!!!

Wendy said...

OH KRISSY THAT IS FANTASTIC NEWS!! Way to go MOM!! You keep on fighting and Mason will keep on doing well...he is loved!! I am grinning from ear to ear just thinking about what you have managed to accomplish!!! YES!!

Susan Dupre said...

Oh Krissy, this brought tears to my eyes. You have ought so hard, and I am so thrilled things are paying off for you. Yay, for you for sticking to your guns. It is people like you that make a difference in this world. You think you can make it a Nationwide change now? Hugs to sweet little Mason. He is so fortunate to have a wonderful mom like you. I am so proud of you. :) Big HUG to you too.

Tracey said...

" It is impossible to win the race unless you venture to run, impossible to win the victory unless you dare to battle" I can't think of another person this is best suited to, you always dare to run and you always dare to battle, I am so incredibly happy for you and your family, especially Mason, take great comfort in knowing YOU achieved this, you are an amazing lady and an even more amazing mommy, your kids are so lucky to have you help fight their battles (HUGS)

Tara said...

wow krissy, what great new!! love u're word!!! you r such an awesome mom,,, my hero!!!

Oh Scrap!! said...

Krissy best of luck, never give up!!
My son Nolan is already 18 and a place that helped me was the Option Institute,here is the link;
http://www.option.org/option-for-autism:the-option-institute-and-autism,single,200
Hugs,Rosa.

Stacey said...

You totally rock!! You know how excited I am for you!!! Yay!! See sometimes it pays to go "psycho Mommy" on them!! lol

Gabrielle Pollacco said...

OMYGOSH!!!!!!!!! YIPEE!!!!!!!! I'm so happy for you Krissy, no one has fought harder than you for this, I'm so glad to hear he is going to get all the care he could possibly need!!! You're an awesome Mom and Mason is such a beautiful little boy, I'm delighted for your whole family!!

{{{{{{HUGS}}}}}}} Gabi

Oh Scrap!! said...

Hi Krissy the Option Institute basically helped me to see my son the way he really is, I learned to see though his eyes, to truly know him and how to help him,he stopped taking at 18 months didn't talk until he was 4 years(he won't shut up now) and I had him on treatments since he was 2 years old, he has received any and every kind of therapy I could find, from brush therapy to therapeutic horseback riding, music therapy, art and drama therapy,etc..diets and I had him on many different kind of schools he is at the moment and since he was 16 and 1/2 in the Kolburne school in Mass.
He has now the label of Asperger’s syndrome as well as ADHD and he still has issues with central auditory processing which is something most kids with autism have even though he received Auditory integration training (AIT) which helped him a lot with his speech
At the moment since we only have each other, he is been thought how to live and survive on his own (just in case) and you'll be surprise of what they can learn when mom is not there to do it all, he can keep a conversation with you, talk about pretty much anything specially movies, he is pretty much independent he need reminders, he needs assistance on little stupid stuff like a specific amount of shampoo on his hand instead of handling the whole bottle(he will wash the tub and floors and make a huge mess just because you know is fun...he is not as hyper as before, he can make himself some meals but he is very good ordering at a restaurant, he is very silly and funny, he remembers everyone's birthdays and has is convinced that he is an angel and he is in direct contact with God even though we don't have a religion,he believes in Reiki and was thought how to use it too, he loves music and he is very high functioning socially but educationally is basically at a 2nd grade level specially in reading O math he knows how to spend the money, no clue of he actual value even though he has work before at a library putting the books back, activating the alarms , rearranging things, perfect place for him, quiet,full of books and videos his fav stuff, he has learn to accept No for an answer and that has made my life so much easier, he still lives easier on a routine, he is 6' now i am 5' he is very much like me talk a lot and tells it like it is so he gets a lot in trouble for that, he is usually the one that can make everyone else get into mischiefs and also the first to take care for someone that is sick O sad , it has not been easy specially because i had to do it all alone my ex stop seen him when he was5 but i think Nolan is a great kid and he has so much more to learn and he will it has taking longer than a regular kid and in different ways but is doable, they can learn pretty much anything they just see the world different than us,never give up on your child and make sure he is above anything anyone can possible say, no matter who he is annoying he only had you to fight for him, tell him how much you love him all the time even though he knows it, the most important factor on getting him better is the attention, love and dedication you'll have for him, well you can tell i can talk about Nolan all day, if you need any help any information,e-mail me
scrappinginny@aol.com
hugs,Rosa.

Tracey said...

he he he me again, I promise I am not really stalking you, this time it is to challenge you - check out my blog for details XXX

Tracey said...

And yes again, now this really does qualify as stalking lol, no idea about the sketch programme you asked about but if I find out I will let you know XXX

Helen M said...

Way to go...getting the help you need for your son.
I just read back many many of your blog entries...from bloody strangers at your door to little girls having a spa day! What an amusing life you lead!
Helen...aka mazuntex (just in case you're wondering!)