To our Arizona State Legislature and Governor Hobbs:
I have read that some in our legislature have blamed the governor for mismanagement of DDD funds. And to Representative David Livingston and all of the other esteemed members of our state’s appropriations committee, I would like to propose considering that another explanation is quite possible to exist. During our most recent DDD planning meeting for Tony, his support services coordinator mentioned that she is hearing from more and more families she works with that their commercial insurance is no longer being accepted for those services, services that they had previously been accepted for.
I myself recently received a denial letter for medically necessary speech therapy services given to Tony (speech therapy for an individual using a speech device consists of teaching creating expanded phrases via AAC) after the new insurance plan through my husband’s employer took effect, services that used to be covered. I was told that ours were denied in error (after of course listening to an automated message that says anything verbally told to us over the phone would not be binding, but rather the terms of the contract would determine coverage/payment). I received messages that his medically necessary PT was also denied (for sessions that were done before the provider realized our insurance had changed to UMR, services have remained suspended since they became aware of that information pending receipt of an actual payment or denial that can lead to services being billed to DDD in the entirety), and they were told the plan excluded these services.
Both the business and myself in follow up conversations with UMR were told that our particular plan doesn’t exclude those services, but that their system was set up to erroneously deny claims for all these services under this employer’s plan and it would require a minimum of 30 days to fix. I am not sure what to expect, because honestly, I have documented a different answer from them as to what is going on and will happen each and every time I call them. I was told by their rep Pam, however, that many UMR plans do not at this time cover pediatric therapy services for diagnoses such as Autism. I was also told by our son’s provider that until they have a paid claim through UMR or a denial that can be billed to DDD, his services will remain suspended.
But for those plans that will actually no longer cover these services that perhaps used to? The full bill is going to DDD whereas before only part of it did. That would indeed cause spending to be above what was previously considered necessary without any mismanagement being involved. That’s the nature of insurance in a capitalistic society where companies can determine what they will or won’t pay for any longer, and if something is too expensive? If there is another possible alternate payor?
It is my hope that we will not politicize this issue, but will look at the actual needs of our community members serviced by DDD and ask ourselves what we would want if we were the disabled individual, if it was our child, our grandchild. “There but for the grace of God go I” is an apt statement in these times for many. DDD and ALTCS are the safety nets that allows many individuals in this community a chance to have the sort of lives we ourselves personally might be less likely to object to having if these challenges were indeed ours.
*For those of you who read this before Wednesday’s post, there is another post further down the page on this subject, so kindly keep on scrolling through to read it 😀
And, because anybody going through this will need a stress relieving activity, these were from some of mine for the past week…digital puzzle apps are great if you could have to spend time on hold, etc.
