Tuesday, April 17, 2007

A Basic Question

Last July I officially started my current job, which was essentially a promotion from a 50% FTE graduate assistantship to a 75% FTE graduate assistantship with supervisory responsibilities. The money was "good," and as a result I had no need to take out another student loan. The money was not "great," but for 30 hours per week, I had no complaints.

However, I am still on the student health insurance plan. The alternative, had I been hired as a true 75% staff member, was no insurance coverage at all. So, I was thankful to have been hired on as a grad-student at the salary I'm receiving, and I thought the student insurance plan was OK. Not great, but OK.

Moose wasn't on this plan last year. He was on a state-funded plan for which we qualified because our income was so low. This was a wonderful insurance plan, especially for a child with special needs, as it covered just about everything with no premiums or copay. Don't get me wrong: I'd rather not qualify for the plan due to high income, but I do miss this plan. We took him off the plan January 1.

Today we learned that the speech and occupational therapy (OT) he receives every week has not been covered since the start of the new year. Earlier in the year when we were deciding to switch him to this "student" plan, however, Wife called the insurance company to verify coverage, and they said "autism is covered." However, what was not clear was that they only cover "medical" expenses for autism, and not speech and OT. Speech and OT are only covered expenses if they are restorative. So, if I had been in an accident and needed to relearn how to use a fork, that OT would be covered.

Moose has never been able to speak. OT has taught him how to do things that other kids just learn, like using a fork, for example. My basic question: how is it that therapies provided by a hospital, and prescribed by a doctor, are not medical expenses realted to autism?

We are appealing, and we hope this turns out OK. But, what if it does not? Do we cancel therapies till we hear? The appeals process takes 30 days.

These insurance plans are designed for students, who typically are healthy and normally-functioning individuals. I mean, they got into college, after all. The plan covers prescriptions, doctor's visits, etc. That's all well and good, but when you realize your child has a mental disorder during a five-year stint as a graduate student, it'd be nice to at least be told what questions to ask in this regard. We would have found another plan or found another way to get the therapies had we known...

I may not have taken this job had I realized these essential things for Moose's care were not covered. On the other hand, this job has probably helped lead toward some bigger and better things (more later on those). I'm torn. Am not sure the money was worth it.


Anonymous said...

Oh come on. I just got finished with my own health insurance-related rant in my own blog. I hate, hate, hate the IU plan. Maybe I will end up hating all my health plans from now on, as they all seem to be getting progressively worse. But still. I can't believe the coals we are raked over.

I hope this turns out for the best.

EA said...