T & A #2 fingers crossed!

[911RN]

Insurance companies spend millions upon millions of dollars lobbying the government in regards to coverage. I do not honestly want to know to what degree they control what is covered as it would likely infuriate me. We have BCBS and they alone spent almost 10 million dollars lobbying with the government this year and this has been going on for decades. In 2006 BCBS spent over 8 million prior to Obama even taking office, so it has little to do with Obamacare. Insurance corruption is one of my pet peeves I no longer really have the time for.

 

Our insurance company does not cover office visits or most labs if that office visit/labs is related to autism (among other dxs). Heck, we pay them almost 400.00 a month to cover only kiddo and she has no vision or dental either . Our immuno incorrectly placed the dx as autism for the first two office visits we had and several of her lab work. We never even discussed autism during the visit. I am fighting with them to get them to cover the office visit that were correctly recoded and then denied again. They want proof now that she needed to be seen by a doctor for starters and then proof that the visit was not pertaining to autism. They may cover them eventually, but I am not holding my breath since this has drug on since April already. Point being, an insurance company covers only what is outlined in the policy, and much of what they do not cover are medically proven dxs, treatments or meds. We are responsible to read our policies and if we do not like what they dictate, then we are to find another company that is more to our liking. In my families case, kiddo is only eligible for one policy based on her dxs. If we do not like what she currently has our only other choice is no coverage at all. In January all the pre-existing stuff changes, and the coverage kiddo has will be terminated since it is only for those otherwise uninsurable due to pre-existing.

 

I worked in pharmacy for 20 years and watched insurance companies buying out drug companies, then stacking their formularies in favor of the companies they themselves owned rather than based on safe, common, or generically available medications. I really do not want to know the complete picture of corruption in the medical and insurance industries in the US. I do not have the energy or time to become that enraged any more.

 

There hasn't really been any official studies on if a tonsillectomy helps a child that already has pandas. The study done has shown that it won't prevent a child from getting pandas. Our pandas ID dr said studies show there is a decline in post t and a strep infections but by the end if a four year period there are as many strep infection as before surgery. Of course for me, I was willing to take the reduction for four years knowing he would eventually outgrow this condition.

 

My dd was cured completely after t and a but only for 6 weeks and then she flared. Now she does have little flares here and there lasting from a few hours to 10 days, but in between she is her 100% self.

 

DS had the surgery and flared terribly for 5 weeks! But I must say now he is doing amazing ly well but still has awful adhd and mild icd, anxiety and tics.

 

We did both surgeries for sleep apnea. It's not a given that it will help but many feel that it has helped. I am definitely on that team!

I would insist on an ADOS assessment (Autism Diagnostic Observation Schedule). This is considered the "gold standard" testing to see if your child is in the spectrum or not. My son had it done at age 8 after 4 years of listening to professionals, teachers and paraprofessionals nibble around the edges of Autism diagnosis but they never come out and say it. While others said he was not. There were great differences of opinions. I refused to allow him to be diagnosed until they could prove it. The ADOS assessment was done and he was NOT on the spectrum. Did not meet criteria for Autism diagnosis and that put the matter to bed. We all agree he has some autistic characteristics (more Asperger's actually) but being quirky does not make you Autistic. Any neuropsych or trained psychologist in testing can administer the test.