There is just so, so much more to Ryan’s brain injury than caring for him. The paperwork is endless. Legal issues and research, aside from the worthless thugs that caused this, are something that most readers might not think. For example, to simply obtain guardianship of Ryan, we had a lawyer visit our home, file a petition, and have a court hearing. Then… there’s insurance.Insurance Game
Ryan’s therapy visits were approved through last week. As usual, the head therapist came out to do an assessment and submit this for insurance re-approval. We have always heard back within a business day or two. Well, not this time. We are four days out from submission now.
Last week we caught wind that the insurance company was starting to push back on the number of visits. They seem to be taking the position that Ryan is not showing significant cognitive improvement to warrant the current schedule of 3 days each for Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST). In layman terms:
- PT = Toes to Waist
- OT = Waist to Neck
- ST = Head
The logic by the insurance company has me confused. It really does. My question is, “Do they expect everyone to get smarter from being stretched and ranged?”. When I broke my ankle two summers ago I have no recollection of insurance requiring tests of my cognitive improvements while they rehabilitated my ankle. Why should this be any different for Ryan? He gets PT and OT to maintain and/or improve his physical well-being, with the hopes of cognitive gains as a derivative.
As for ST (which has very little to do with speech, by the way), wouldn’t it be wise to increase the visits? At least to see if it is worthwhile?
I get it. Insurance is in the business to make money. They have risk models. They have algorithms to hedge. They know the odds. If you get right down to it, they are betting you won’t need them… at least not need them beyond a certain threshold. We are betting we will.
Why does it have to be this difficult? Can’t they just deliver what all those premiums were paying them to bet on Ryan’s health? We insured ourselves against catastrophic loss/injury. Like them, we hedged. We hedged even though it was highly unlikely we would need them to this extent. Sadly, we need them to meet their obligation to us now.
Although not where we want to be, Medicaid has approved more hours to pay me for caring for Ryan. They initially agreed 41.5 hours per week. We countered and appealed, asking for the full 84 hours (12 hours a day x 7 days). Meanwhile, no money has exchanged hands.
Really, we weren’t asking for a single minute beyond what I provide. I could argue that, even with a night nurse, we are still “on the clock”. The truth is that the care never stops for us.
Still in appeal, Medicaid has approved 63 hours per week. It looks like they simply split the difference between what they were offering and what I was actually doing.
With that said, I must also say I really appreciate the financial reciprocation. With Jon May and Austin Vantrease (and their families) ignoring their court-ordered retribution, any amount helps a lot.
This leads me to one more thought, which I’ll close on. Why aren’t the Vantrease and May families holding fundraisers to support their sons (and Ryan)?