When F was young, between the ages of one and three he was growing quite quickly. We didn't think about how we'd bathe him when he outgrew the infant tub or where he would sit when he was overflowing out of his bouncy seat. It didn't come to mind until he no longer fit.
F received PT and OT during those years through CCS MTU. He saw therapists at least monthly, and yet, these questions were never asked of us how we did accommodate daily living activities. It was when we had problems with fit that we then asked questions. It was pretty frustrating to need a piece of equipment and then have to wait to work the process of authorization and approval.
I tried to learn very quickly to start making a list of questions for therapists and clinics. Questions like "how will I move him into the bathtub when he's too big?" or "how do I know when his wheelchair needs adjusting, what might that look like?" I tried very hard to make sure I planned. I started to ask a lot of questions to plan for the future. In the early years I had to rely solely on the vendor we used and/or catalogs available. The internet was just beginning to take on shape and there was little information. Now if you have an idea of what you need you can find several products that meet your needs to get ideas.
Then here was the process off authorization and approval. I tried to get to know the process of CCS (California Children's Services) Many individuals don't realize that CCS authorizes Medi-cal to pay for eligible items instead of a TAR (treatment authorization request). Then if you have private insurance and CCS, you would need the denial or copayment from the private insurance for CCS to pick up the cost or balance. It's helpful to know the order of things private insurance first, CCS, Medi-cal, Regional Center. The Regional is the last opportunity of funding if you have denials from all other coverages. This can help you so don't get the run around for your referrals and/or authorizations. It can be a lot of work, but it will make your life easier and less frustrating. It amazes me how many people who don't take the time to know the process, because they don't have the time, don't want to make the time, or just don't want to be bothered. They will purchase privately and in my opinion these are funds you have funded personally by health insurance premiums or tax dollars. It's already your hard earned dollars, make them work for you.
It's wise to learn about your insurance policy. Know your DME or durable medical equipment coverage. Does it have a yearly maximum. Are these types of items covered: specialty formulas, incontinence supplies, orthotics and splinting, etc.? It's also very helpful to know the process required by your insurance company for referrals, networks providers, etc. If you know the policy and what you have access to, it can be helpful when you meet with doctors. If you know that you have a referral coordinator get to know them. Sometimes authorization is as simple as the language on your prescriptions. The language can make all the difference.
Some families with CCS don't know this because they are new to the system, but they can have a chart review done by the doctor as requested by the therapist. I'm not sure if I am wording this correctly, but as I recall, it wasn't necessary to get orders for equipment by going to a CCS clinic. I could call or meet with the therapist. She would make the recommendation to the doctor. The doctor would review the chart and recommendation and write the orders.
Just learning to navigate a health care system can be time consuming, but if you take the time to figure it out you can save yourself valuable minutes in the long run or you can get items or services because you've taken the time to get to know the process. I am continually saddened when I hear about children being underserved or without equipment because their families don't understand the process. Sometimes it's due to a language barrier other times it's just they didn't realize that they could get the information if they had only asked the questions.
CCS and the Regional Centers are available in California.
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