Insurance Stinks!

Kitty who has RAD, complex PTSD, bipolar disorder, ADHD, LD, ODD… and a half a dozen more letters was placed in residential treatment on 8/19. This year she’s been hospitalized twice for suicidal issues, and went to a partial day hospitalization program that made her worse because the kids were out of control and the staff didn’t do anything about it. We pulled her out after 3 weeks, because we couldn’t handle the almost daily rages at home anymore. She has always behaved well at school and in public of course. Gotta love RAD!

This Summer I stayed home and we made her life as simple as possible. Grandma watched the other kids and I stayed near Kitty to help her regulate and stay calm (she can’t do it on her own). She verbally threatened the life of Grandma and our youngest son, MANY times. I don’t know that she would actually follow through with physical violence to them or herself, but that does mean I don’t want her to be in the care of Grandma with her little brother around all Summer. Meanwhile we started the process to get her authorized for residential treatment (RT).

She was adopted from another state, Nebraska, and we had RT written into her subsidy because TX Medicaid doesn’t cover it. So the RT recommended we get their pre-authorization prior to going through our primary insurance. Took them 3 weeks to say, well it’s up to your insurance, but we’ll cover her as long as we deem it’s medically necessary. When we talked to our primary insurance they approved it and she was in the facility the next day! That was the good news.

8 days later our primary insurance said she didn’t need to be there, because she wasn’t acting out. My child has RAD, so her issues are mostly with family. Plus, although it almost killed the family, she’d spent an entire Summer almost stress free. Hello! Can you say honeymoon?! The RT appealed because they saw the need to have her there (for one thing, she didn’t talk much, but had told the psychiatrist that she had suicidal thoughts). Appeal denied. They contacted NE who thought about it for a couple of days then left a message after hours saying they were refusing to cover her either. So she comes home tomorrow.

We are flat broke so the RT will have covered 9 days out of their pocket! They also pushed all the neuropsych testing (the main reason we chose them) and it will be finished today. (Can’t wait to see the results although we’ll probably have to wait a couple of weeks). Contact me off-list if you want the name of this RT. They do not specialize in RAD and are VERY expensive if you don’t have insurance, but they are great to work with.

So at least we got 2 ½ weeks of respite out of this and the neuropsych testing (our insurance doesn’t cover any mental health testing which seems short sighted to me). *sigh*

Mary in TX
http://marythemom-mayhem.blogspot.com
Mom to biokids Ponito(10) and his sister Bob(13)
Sibling pair adoptive placement from NE 11/06
Finally finalized on Kitty(14) on 3/08 - 2 weeks before her 13th birthday!
Finalized on her brother Bear(16) 7/08. He turned 15 the next day.

" Life isn't about how to survive the storm, but how to dance in the rain."

Insurance and other sh** (poop)

At 4:45pm yesterday, I got a call from the business office of the partial day hospitalization program that Kitty attends. They just wanted to let us know that as of Wednesday, Kitty was being "stepped down" to their outpatient program. The only thing this changes is she would see the psychiatrist once weekly instead of twice, and family therapy goes to every other week or stops all together ( I forget which). She still attends school and group therapy.

Which would have been fine except for the next part. Insurance pays for all of the partial day hospitalization, but SURPRISE this new program is considered "out patient" which means we have to pay a co-pay for the services. That's $25 A DAY! Starting that day. $125 a week! They don't take Medicaid so we have to pay the co-pay, which, by the way, they want to discuss how we plan to pay this and the $1500 deductible that their records show is still owed! If we don't pay then this will be like any other debt and will be charged off (sent to a collections agency).

Needless to say, I FREAKED out! We are broke. Beyond broke. Kitty's doctor bill co-pays are already draining, Summer is coming which means we have to find all day care (Grandma will do it, but 4 bored kids, two of whom are emotionally disturbed, requires some sort of activities - which will cost money and lots of supervision (unwanted by the kids) - which is asking a lot of my mom).

So on the way to family therapy this morning, I called our insurance. Medicaid had met/ paid our deductible when Kitty was hospitalized in January so even though the hospital hasn't submitted a claim for April (which I still find hard to believe - don't they want their money?), we are still covered. *Whew!* Nothing they can do about the co-pay though.

The hour and 45 minute "Family therapy" ended up being more about case management then family therapy, and we didn't even bring Kitty into the room. Every family therapy session we had, we questioned whether or not we were doing the right thing by keeping Kitty in this program.

Our concerns:

• Kitty is exposed to kids with way worse issues then we were led to believe. The kids in the PDH often interact with the kids from the residential treatment center (RTC), and the kids in the PDH are often just released from RTC and seem to quickly end up back there. This was the RTC we wouldn't even consider for Bear (who they planned to put in the ward for "aggressive boys"), because one of their first questions was "Are you OK with him getting beaten up daily?" Uh, NO!!



• Kitty has been kicked, cussed at and told she "smelled like a litter box," had her seatbelt repeatedly stepped on in the van, had her hair pulled, allowed to listen to Hip Hop on the radio (very big trigger for her), was exposed to a picture of a scantily clad female classmate while working on a team project on the internet, witnessed kids fighting and punching each other in the face...



• She has to be at the school bus stop (20 minute drive) at 6:45am and doesn't get home until after 5pm. Let's just say she is not a morning person, and often has difficulty with insomnia.



• This environment is SOOO much more stressful then public school that Kitty was coming home so triggered she had meltdowns almost every night. We had to remove everything stressful we could think of so that Kitty wouldn't get more overwhelmed then she already was (taking chores to a bare minimum with little enforcement, allowing Kitty to spend almost unlimited time outside on the swings, removing Grandma from any responsibility for disciplining Kitty...).



• The psychiatrist was on vacation for a week so Kitty had no med changes for the first 1 1/2 weeks in the program and then they seemed to want to change every thing at once to "make up" for lost time. They actually called me something like 5 times in one day changing their minds about what to start, when and how (the last call was at 9:30pm) and they still made yet another change the next morning.



• The Family therapist, who also does group therapy with the kids, seemed very inexperienced, and is actually only an intern.



• Kitty was not participating in group therapy, and while not completely superficial does not seem to really be dealing with any of her issues.



• Kitty has begun to mimic the behavior and attitude of the other kids. Trying on new personalities at the drop of a hat. Parroting attitudes and language at home. Often its talking "gangsta," or "I'm a teenager, I DESERVE to have..."



• She realized that she needed to behave at home as well as in the program in order to be released, and her behaviors at home miraculously improved (mostly). The PDH used this as a reason to "step down" her program.



• Kitty "has" to have a BFF (best friend forever), but has very poor social skills so has trouble maintaining friendships. The girls at the school also have issues, usually including poor social skills as well, so Kitty is constantly dealing with girl drama.



• If we remove her from the program and send her back to public school this sends a message to the insurance company that she is "better," and if we decide we need additional treatment (including RTC), we might have to start the process over again (probably including another trip to the psychiatric hospital).



• Our AT (attachment therapist) can only see her every other week, while therapy at the PDH doesn't seem to be helping much is it better than nothing? (She still sees the AT even though she's in the PDH). There don't seem to be any other alternatives.

The good things about the program:

• Until her meltdown last night (over being asked to clean up toilet water from a toilet she clogged and attempted to flush), she hadn't said she "hates this family" or talked about going back to Nebraska for a week. Of course we don't expect this to last when she is out of the program.



• There is generally a quick response to my/our complaints.



• They are actually required to care what happens at home (public school doesn't care what her behavior is like at home if it doesn't reflect on what happens at school).



• Someone is there to supervise med changes and watch for side effects and results.



• Adding Lithium has seemed to have a positive effect, although it's a little early to tell (5 days).

Once she's been "stepped down" we can't step her back up to the PDH, even if we start reintroducing stress into her life (like, Heaven forbid, actually expecting her to wash a dish!) and allow her to meltdown/rage again.


So after a long talk with the PDH psychiatrist and the family therapist we have decided to remove Kitty from the PDH on Monday. The public school has already said they will be happy to welcome her back and she will just go right into her old class schedule - which of course she was in when this (suicidal ideations and being miserable and angry) all started. Nothing is changing at home, so I'm thinking we might need to rethink the school structure. Possibly taking away electives and putting her in resource room classes instead.


OK here's the TMI (too much information) part about Kitty's bowels (I did promise to tell you how it all came out) so please feel free to stop reading now.




It's not too late!




OK, you asked for it.




Kitty finally pooped last night! The crazy doctor recommended I give my 14 year old, emotionally disturbed, sexually abused, major mom issues, daughter an enema. Luckily the nurse practitioner knew that was pretty much not going to happen and gave me some other alternatives.


Kitty took 2 doses of Miralax in apple juice, 6 teaspoons of mineral oil (to smooth the way) in an Activia yogurt, and a small bag of sugar free candy (she loved me for that one!). I didn't see this one so no disgusting descriptions of the anaconda in the toilet, but it did of course clog the pipe when she tried to flush it and the toilet over flowed (1/2 an inch of water everywhere). Hubby had to help it along and then insisted that Kitty help dry the floor. This triggered a meltdown, which while not of epic proportions was still pretty bad - no restraints or physical violence thank goodness.


She was disappointed that her tummy was not instantly flat. I assured her that there was probably still more in there, and this morning gave her Miralax in her Smooth Move tea (chocolate flavored laxative tea - can you imagine?!). If that works, the school can deal with it.


So now we'll see what the day brings.

The Straw that Broke the Camel's Back

It's been a long tough year. We've managed to muddle through it. I've been doing so with the help of pharmaceuticals (prescribed!). I still don't know how Hubby does it. Today may have been the last straw.

Yesterday we had to lay off one of our employees. He wasn't surprised (we haven't kept him busy in a long time), and he took it well, but it was still very hard.

Money has been super tight all year. I don't know where the money for anything will come from. We've been angsting (is that a word?) over how to handle the private school issues but we have no idea where the money for next semester's tuition is going to come from.

Our car insurance lapsed in August (right after Hubby accidentally hit the bicyclist), although we didn't know it until September. We didn't have the money to reinstate it so we've been driving extra carefully.

When we were almost to work this morning, there were several cars stopped waiting for someone to make a left turn and Hubby didn't notice in time. Actually he did notice in time, but the anti-lock brakes didn't work well. We had a minor fender bender with a brand new Beemer. Beyond the white stripe from our front license plate you couldn't see any damage on the BMW, but the guy was understandably nervous. When he found out we didn't have insurance he insisted on calling the police. We didn't really blame him, but this is not what we needed!

Luckily we were only cited for not having insurance. Not for the collision. It's too late to reinstate our insurance (over 30 days), and when they found out we'd been in an accident they refused to cover us at all (even though they wouldn't have to pay for any damages because we weren't covered). Maybe because this is Hubby's second accident. I hate working downtown! Now we have to find another insurance agency.

So I'm trying to think of this positively. God must have a plan. I'm thinking that this could have been a MUCH worse accident and God protected us (or was protecting the other driver). I hate not knowing God's plans in advance!

I just hope things will turn around soon. I don't know how much further we can/should go. Maybe I should follow my friend Lisa and cut back and try the Depression lifestyle. I grew up that way, and certainly know how to do it.

This weekend are our family pictures (still haven't finished altering Bob's dress) and I have to make 26 pies! I know I'm insane.

Kitty Therapy

The original plan for Kitty's therapy was for her to go to EMDR therapy for the Summer and then go back to attachment therapy. She was having a lot of issues with her PTSD (post-traumatic stress syndrome) and dissociating and meltdowns. We watched a video of how EMDR works and it basically said 2-3 session and the person was able to process the event(s) without the emotional turmoil. So I have been pushing the sessions to get Kitty to address her biggest triggers/ issues.

I talked to Kitty's attachment therapist about setting up appointments again, and she asked if I had talked to the EMDR therapist about it. Well, no, I'm a big e-mail communicator and the EMDR therapist is not, plus she's a super busy person. She reads this blog sometimes though! So tonight, I/we pushed Kitty through another session (we've been alternating difficult with easier sessions and tonight was scheduled to be a tough one), and then sent Kitty out of the room for a talk.

Oops! Basically the EMDR for a single event (like a rape or car accident) is 2-3 sessions. For long-term trauma and abuse it could take more like 2 years. Guess which the therapist was predicting for Kitty?!

Kitty is much better. She no longer obviously dissociates when we talk about birth mom or her abusive men -before, she wouldn't answer and would focus on anything else in the room, would change the subject, would walk/run away, and even got violent. Now she stays put, and only sometimes says, "I don't remember."

I was very interested in working on Kitty's somatic issues with the attachment therapist (something we were just starting when Kitty switched to EMDR therapy), but according to the EMDR therapist Kitty is not ready yet. That basically her lack of awareness about her body (not sensing hunger, food on her face, not caring about body odor, not being ticklish, actually inviting others to hurt her by pinching or hitting her to prove that it doesn't hurt her...) is part of her dissociating behavior, and that when she is (much) further along we'll see a dramatic improvement in her awareness of her body.

So now I'm thinking it would be great if I could see Kitty's attachment therapist to help and support me in continuing to provide the therapeutic parenting and deal with attachment issues, while Kitty and I continue with her EMDR therapy. The only problem is that the attachment therapist is not on our health insurance. She would be paid through TX Medicaid which of course I don't have. I'll call her today and see if we have any alternatives.

Squeak!

Insurance dodge

Almost forgot my favorite part! After being transferred to yet another person in the insurance company, who was very nice, but still couldn't find me in the computer, she says,

"Well, I'm sorry, but I'm going to need to talk to someone from your Hubby's company - specifically someone from HR."

I got to reply,
"Well you're in luck then! My hubby and I own the company, I'm the president and I do all the HR! So, 'Hi, How can I help you?!"

She stammered,
"Oh, I've never had that happen before."

And then she proceeded to ask me NOTHING that I, as the spouse of the employee, couldn't answer! So yes, I believe this is just a way to say I have no freakin' way to help you and I want to get you off the phone.

She was always perfectly nice while giving me the runaround though so I won't tell you the name of the insurance company. See, customer service pays off! Well, that and the fact that they are the only insurance company that our psychiatrist accepts and we don't want to change psychiatrists.

Mary
Mother to Kitty
Spouse to Hubby
President of _________
The entire HR department!

Phhbbt!

So Wednesday night we took Kitty to the psychiatrist. I asked him about possible bipolar disorder (Bear has it) as her moods are swinging hard. It's so confusing because it could be hormones, starting school, biomom giving birth, but who knows! She is so angry and defiant sometimes, but it's just out of the blue lately. We had moved past this, but maybe it's just time to revisit it. *sigh*

So the psychiatrist said we have to get her tested by a psychologist. No worries, I called the one who saw her a little over a year ago. He doesn't take our insurance. I called the insurance company to find someone who does. They couldn't find us in the system! They would say, "Oh here you are!" and then say it would be the account through my husband's former employer, or they found Kitty, but under her birth name, or they found Hubby, but couldn't access his account. My favorite part? They switched us to another person who was very nice. She said she'd found Kitty, but for some reason she wasn't associated with any account and they had her last name wrong. She is fixing it for me, but it will take 5-7 business days to get it correct and be able to tell me what our benefits are! *sigh* I love insurance!

So after getting off the phone with the insurance person it was time for Bear's therapy. We started with the "Pumpkin Patch incident" and the Ipod borrowing incident. As usual, he was telling the truth and someone else "misunderstood." The therapist got Bear to admit that he lies, steals and is sneaky, and that he should not expect us to have a lot of trust.

Hubby approached the knife issue in an interesting manner. He said, that following the conversation we just had, he knew it was going to be very difficult for Bear to tell the truth. That he wanted Bear to stop and think before he answered Hubby's questions and be sure it was the truth. He then asked if Bear felt threatened and unsafe by anyone in the last few months. Bear said he felt threatened by some kids at school and that he always made sure he was near a teacher. Well, we know he has PTSD. Hubby worked his way around to dicussing what Bear was doing about it - whether or not he had any weapons (at this point I'm sure Bear knew he was busted) so he admitted to the knife, but claimed he gave it away (but the boy may not have heard him say he could keep it). Basically he tld the truth, largely, but I sincerely doubt it was completely.

So the question was why hadn't he told us. Well that was because we weren't around enough of course and never listen to him! When he tried to talk to me I "didn't listen" and "spend too much time on the computer." Hubby was "always working" and never does anything with him. The therapist said this was a recurring theme in their sessions. Bear said his foster brothers had never talked to him and his foster dad was always too busy (this is funny because he always says he wanted Hubby to go hunting and fishing with him like foster dad always did!). Bear said the reason he wanted to be adopted was to have a family that would spend time with him. He started crying and talking about how he wanted to spend time with us.

Am I a horrible person that it didn't really move me? The therapist asked, again, how much time I spend on the computer. I told him I usually go on the computer about the time I put the littles to bed (about 8:30) - this is less time than I used to spend, in fact I deliberately started putting it off until then after the last time I got fussed at by the therapist (before, I would get on as soon as I was done with dinner because the kids were all just sitting around watching TV). Bear tends to corner me in my computer cubby about 5 minutes before bedtime and talk for about 10 minutes after bedtime.

Today, Hubby and I talked with Bear and the therapist about how he always wants to talk on his schedule instead of ours. He didn't think it was fair that we only wanted to talk when it was convenient for us! Impasse. I mentioned that I'm available for hours before bedtime, but he's off doing something else. The therapist said he needs to join in the activities - helping with dinner? And that bedtime is a vulnerable time and I needed to stay off the computer until after Bear goes to bed.

So tonight I come downstairs from tucking in the littles, and Bear and Hubby are watching ESPN - not interesting to me (or really to Hubby, but they're together). So I got on my computer. 10 minutes later Bear hunts me down in my study - the boy has the attention span of a gnat. We talk for about 5 minutes about whaat he wants to do with his day off tomorrow, and then he decides to go to bed early. I don't want to sit around waiting for him to have time to talk to me. I don't want him to feel totally ignored either. Not sure how to handle this.

Now the really fun part. I'm getting on my computer later so it's later when I get done with my e-mail, blog reading, forum reading, and blog writing. Now I get to go upstairs and take a bath. Lets hope it's not after midnight again. Maybe if I get more sleep I won't actually need the mood stabilizer!

Sweet dreams!

Mary