ABA Anxiety

So John started a new job in December. It has been a much-anticipated change and move for him with less stress and more money after many, many years of working 60-70 hours a week, virtually unnoticed and unappreciated by his former employer. We had been praying for a position and company like the one that came along for quite some time when God finally opened doors and moved mountains to make the transition a reality and a smooth one.

But along with a new job comes new insurance. Special needs parents' biggest nightmare is the what if's of the new coverage, the hassle of letting every therapist, specialist, and doctor know, and wondering what will and will not be seen as a pre-existing condition.

With John's former job we had Cigna. Cigna did not cover ABA therapy at all and so Jeremiah's secondary Medicaid picked up the bill. We assumed that would be the case with his new insurance, BCBS Anthem. 

We found out yesterday that BCBS Anthem does indeed cover ABA and so his therapy will have to go through the primary insurance before Medicaid will pick up any balance. Jeremiah's current therapists are outside of their network however. We can go outside of the network to continue using them if we want...if we want to meet the $9,000 annual deductible for the coverage first! Oh, and by the way, because we did not get John's new insurance cards until midway through December and wrongly assumed his coverage would be similar to Cigna's, we racked up $4,500 in ABA therapy out-of-pocket for Jeremiah those first few weeks in December. 

Enter hyperventiliation and hysterical tears. Breathe. I didn't even know how to respond when they called to tell me all of this. I hung up the phone, proceded to run my errands, and slowly absorbed the realities of this new dilemma. When I got home, I was so distraught I could not even tell John. Poor guy must have thought I wrecked the van or ran someone over while I was out by my demeanor. I handed him my phone, dialed the ABA company back and let them recount all they had told me since they could do so calmly and without sobbing uncontrollably.

My husband immediately jumped into action. He called his new HR and told them what was happening. The open enrollment period to make changes is over, but they encouraged him to put his request and explanation for it in writing and they would see if an exception could be made. John spoke to his immediate boss who said she would do what she could on her end as well. If they make an exception, we will drop Jeremiah from the BCBS and he will just have Medicaid and still be able to receive his ABA. It will mean paying out-of-pocket the few doctors he sees who do not accept his Medicaid, but they are father and fewer in between than the ABA...and quite frankly, not as necessary. If not...well...

He will lose the "family members" Liz and Bryon and the rest of the ABA gang have become for him over the last several years. He will have no support in school, which has proven catastrophic in the past. What does that mean for us as a family? Well we have a few options.

1. We can encourage him and stress his poor teacher by letting him finish out this school year without support and graduate him in June. He will be 18 in February so that is not impossible. He does still have four more years he can technically attend his school however to get all of the learning, routine, and socialization he can from the experience and so graduating him early would be a very real disservice to him. 
2. I can start attending school with him on a regular basis to be his support.
3. We can pull him out and I can resume homeschooling him...which I can also technically do over the next four years even if we graduate him the end of this school year.

I know a day will come when he will age out of school for good and be home 24/7. We know there are adult day and vocational programs we can look into when that time comes. We just weren't prepared to start looking for them so soon. And because of Jeremiah's develomental delay, he is way too immature to go that route just yet.

On top of the decisions the BCBS determination is riding on, we still owe $4,500 for ABA for the month of December. So much for the increase in pay for John at this new job. Why does it always seem to be two steps forward, three steps back...in so many areas of our lives? Very frustrating. 

Trusting God. This didn't take Him by surprise though it took my breath away. He is still in control, still on His throne, and still working ALL things out for our good and His glory. Pray for us friends!

UPDATE: We heard from BCBS and they are dropping Jeremiah off as of January 1st. So he will not lose his ABA and will still have support at school when he goes back next week. We just have a new $4,500 bill. I'll take that over no ABA anyday.