I don´t like to mention it much, but as a single mom with one job (sole source of income) and three kids I am not super flush with cash. I am lucky in that when my deductible on my insurance comes up each year that the state steps in and provides me with subsidized insurance for the few months that it takes for me to hit my limit again.
This year, as last year, the state has decided that one child´s medication is suspicious. It is, of course, the most expensive medication any of us take. It is exactly one fourth of my monthly income- for a month´s worth of medicine. So the state requests documents and papers from me, from the pharmacy, and from the doctor- most of which it rejects as not up to their standards or missing something. Last year this game went on for exactly five months, which was coincidentally when my deductible was up and my private insurance kicked in to pay for it all. That is when I received the paperwork stating that the issue was resolved- that the medication would be covered by the state (if my private insurance wasn´t already paying.. supposedly).
Last year I tried every other sort of medication combination that I could when I could not pay- and my son did not do well on anything else but Clonidine ER in pill form (never the patch, never again). This is not medication for my autistic son, either. This is medication that my PTSD child takes so that he can control his impulses, his lizard brain. We had a huge discussion on the lizard brain while waiting in the pharmacy drive thru. Any moment can be a teaching moment, right? I digress.
This year I was not expecting any issue. Because of the paperwork I received last year I was certain they would not deny my son his medicine this year. But already they have denied the authorization from the doctor. I tried calling today (their customer service and state ombudsman lines are always busy), put in another request through the pharmacy, and also let my county representative know what is going on. But I am not beating about the bush this year. I am going to pay upfront with cash and keep my son on an even keel.
I am lucky that it is only that much of my income. I cannot imagine having to plan to part with more of it. Tomorrow I pay for the meds and begin a waiting game each month to see if they want to cover my son´s medicine. It seems silly to tell me that I qualify for their insurance because my income is so low, only to have them deny the medicine my son needs and thus lower my income further. But it is better than just paying the full deductible, much better.
Last spring I had a sit down session with the county as a low income mother of a special needs kid to discuss the spending account they have available for kids to get the additional care or therapies that they might need. I wanted the funds to go for the service dog. Of course, you can spend the money however you like in regards to your child´s needs but NOT for a service animal, they informed me. So I turned it down. My insurance covers everything else that autism entails.
My employer provided a health insurance previously that denied insurance to my oldest son outright. Because he is autistic. Apparently, if you are born other than neurotypical, insurance companies have the right to deny coverage. I was outraged until I realized that at least they were recognizing that he was inborn ASD, and not unnaturally so, which was Kanner´s whole take on autism- that it was caused by parenting and not innate. So at least the perception of autism has evolved properly.
So my private insurance is great. My state is doing me a humongous favor by providing me with most of my coverage until my deductible is met, and this financial blip is worth it. My son has made visible progress on this medicine. I am not giving it up.