Monday, December 18, 2006

Vent!

SO... today I spoke to Harvard Pilgrim Insurance because they are telling me we only have $5,200 per member, per calendar year for Early Intervention therapies. We started last February with PT, added Speech, then this summer added OT. The money lasted from February until September, apparently. Umm... hello? A) It is December 18 and I am being told this? and (B) ARE YOU PEOPLE INSANE????

Hi - my son has William's Syndrome... he NEEDS his therapies. As my friend pointed out, it's not like Brady can't hold a pencil correctly and needs OT. He needs to learn to CRAWL! (and walk, and talk, and eat, and....) I was told my recourse is a letter sent to the Appeals division where they will (hopefully) allow us more funds. At this rate, when January starts and the balance is $0 again (because it is reset every calendar year ), we will go through the $5,200 by April. I have contacted Brady's pediatrician and geneticist and they will give me letters to go with mine. My geneticist has already (within three hours of my asking!) dropped a letter to me. I would like to think that this is a standard thing and I will get the funds no problem. Can I point out to Harvard Pilgrim that my eight-year-old son NEVER goes to the doctor? Can I direct any of his leftover monies towards Brady?

I haven't had any problems with insurance thus far (except for one $250 copayment for a hospital visit - ugh) and naively thought the problems I have heard from other people would escape us. Hopefully, they still will. With all the issues needing my attention, this should not have to be one of them.

Other than that annoyance, things have been pretty quiet over here. Brady has been doing really well, reaching out all the time now for his toys as well as sitting for a long period of time and chewing. I finally feel like we can start playing more. Before he would kind of just look at his toys, not really interested. He will reach out now and grab things, always wanting to shake, shake, shake them! He has a little fascination with tiny balls in rattle-like toys and Michael is forever complaining that Brady is making too much noise when he's trying to watch TV.

He has been sleeping more and more and I'm wondering if these six-to-nine-month clothes will fit him long, as it could be a growth spurt. Some of the clothes seem to be getting a little too short, but the waist for the pants in the nine-month clothes fall right off his body.

There's been a lot of talk on the boards about the delay in speech, and Brady is definitely on the quiet end as well. His geneticist said at his one-year-old visit in September that the one thing she was surprised about was his lack of vocals. They are few and far between, with no correlation to when it happens. WELL... there probably is one, but one we can't figure out! Unlike his mother, Brady only speaks when he's got something important to say - he doesn't babble for no reason. :)

I am excited to see how he does Christmas morning with some of the new toys we asked Santa to bring him - especially this drum that plays music when he hits it. I think he will understand how that works. In the meantime, we are making cookies, singing carols and enjoying the holiday season.

6 comments:

Jen Z said...

Ugh! How frustrating. I hope you get it worked out very soon with help from your doctors. I love reading these posts. I don't always comment because of life busyness and computer slowness, but I'm thinking of you and sending my love to the whole batch of you. Love, Jen

Kathleen said...

Harvard-Pilgrim is the worst!! It was 7:30 in the morning after my c-section, two 6-week premature babies on oxygen in the NICU, when a Harvard-Pilgrim rep walked into my hospital room and asked me when I was going to take them home!!! Hopefully Brady's doctors will be able to help get your limit increased!

On another note - I totally forgot to tell you, but when Brady was here Saturday night, the ENTIRE time we were eating dinner, he sat in his chair making those kissing noises! It was so funny. But he must be exploring how those muscles work!

Teresa & Shawn said...

Whatever portion of Clare's therapies are not covered by insurance is covered by a grant through the state for Easter Seals. Does MA have anything similar? Since WS is considered a "qualified condition," we never pay a dime for ANY early intervention services. Something to look into.

Clare was fairly quiet up until a few months ago, then she just exploded. It was after Clare's first birthday when she even started to sound like she was babbling. So Brady may surprise you yet!

Lisa R said...

WHERE IS OPRAH WHEN WE NEED HER!!!!!

Houston Michelle said...

Hi Kerry,

The other Michelle just gave me this blog site yesterday. It is been interesting, and heartbreaking, to catch up on Brady and what you have been up to for the past 14 months. I read the whole blog, and I hope I am considered one of those friends that you don't get to talk to often, but know "you could call up in an instant if need be!" I would clean your toilet if I didn't live so far away! :-) Go Brady go! I can't wait to continue to follow his progress. Take Care....

Tammy K said...

My son Parker is 16 months and has Williams also. I live in MA and we receive Early Intervention, I just wanted you to know we are having issues with our insurance company also. I spoke with Early Intervention and they told me, if insurance pays okay, but if not the state picks up the expense. We (reffering to MA) are entitled to all EI therapies up to age 3 then the school system takes over. Any questions please feel free to email me.(tamray@aol.com)
Tammy