Cost Effective Health Insurance

I want to share some of the craziness that is managing my Autistic son’s benefits. I am very vocal about how everything is a fight…and the services are in a vacuum. The right hand isn’t talking to the left hand. And it’s exhausting. To be honest, managing my son’s benefits is a full time job. I mean that wholeheartedly. Six months ago I learned about Cost Effective Health Insurance Premium Reimbursement. So, listen up if you live in the state of Minnesota. And, if you live in another state, it’s worth a google search to see if your state offers something similar.

Currently, Cooper receives disability based medical assistance (Medicaid). He also receives a disability waiver. I am VERY thankful for both of these benefits! In a weeks’ time though, I make an average of ten phone calls regarding his care. This could be to his social worker, financial aid worker, insurance case worker, his therapists, teachers, etc.  I send and receive at least 25 emails. I typically fax something every week. I also give up every week. And at least once a week I curse everything that is the business side of Autism.

I say things like…’Why is this so damn hard?’ And, ‘Why do I feel like I am fighting for the most basic rights for my kid?’ And of course, ‘Why do I feel like I am being forced to quit my job just to get help?’

Cost Effective Health Insurance

Have you heard about cost effective health insurance premium reimbursement? It’s a benefit that I didn’t know existed and have been missing out on for four years. In the state of Minnesota, even though my son is has Medical Assistance (Medicaid) based on his disability, I am required to have him covered as primary under my health insurance through my employer. This means that my son is double covered. My health insurance pays first. Then the state pays. The state wants the employer to pay first. I found out from a fellow Autism mom that if I can prove that my health insurance paid more than the state did in a given year towards his medical care then I can get reimbursed for his portion of my health care premiums. Your premium is the amount deducted from your paycheck. The state wants to incentivize parents to keep their primary health insurance. It saves them money.

My health insurance covers me and the two boys. So, if I divide my premium by three, that’s the portion that would become reimbursed. That is a good chunk of money. And in the end, it all adds up.

After six long and annoying months I am proud to say I finally got reimbursed. I didn’t give up. Although the amount of hours and time I have into it is RIDICULOUS. And, of course, I kept track of every step of the way so I could share it with you AND hopefully, someday, tell someone important how the system is broken.

The Start

I started by Googling the benefit. Then, I called my social worker about the benefit. He knew nothing about it. Then I called my financial aid worker through Medicaid. She knew nothing of the benefit. I made multiple phone calls to the Department of Health and Human Services only to find out that there was NO WAY I would qualify for this…even though the website said I would. Or at least what I could make of the cryptic description of the benefit. Which of course, made me try harder.

Once I eventually found the right people, that were strategically hidden behind a three minute voicemail, I was told that I should have been informed of this benefit from my social worker. GAH! I asked how the benefit worked only to find out that they couldn’t talk to me about it until I applied. I asked if it sounded like I’d be approved…which in exhausted autism mom language is…Is it even worth me applying? The women on the phone had no idea. So, I applied and faxed in the paperwork. Months went by with me following up every week. I was told each time, after leaving a voicemail, and maybe getting a call back, that they were dramatically behind on this benefit.

Denied

I received a denial letter two months after applying. I started calling again. When I finally spoke to the real life person who was assigned to my case I asked her to explain why I was denied. She struggled to do so. She started explaining that my daughter Jamie was a dependent who received Medical Assistance as well…and I stopped her right there. Jamie is Cooper’s dad and not on my health insurance nor does he receive benefits. So, we started over. I applied again. And I went above and beyond. I pulled every EOB that Cooper had in the last year.  Mind you Cooper had 480 claims last year for $129,261.84. When I did the math myself…it was very obvious that my health insurance paid WAY more than the state did for Cooper’s medical needs. I calculated that the state paid $50,000 or so. Mind you…I can’t see that number. It’s not available to the parent.

Approved

I was approved for reimbursement in March only to never hear from anyone again. So, I started calling again. Only this time…no one returned my voicemails. At one point I spoke to a lady that said ‘yes, she could see I was approved in the system.’ I asked when I would receive my reimbursement and I wanted verification that it was for the previous 12 months. She couldn’t answer my questions nor did I hear from her again.

Last week I politely threatened through voicemail that if a real human didn’t call me back and help me I was going above their heads. I would make so much noise it would be ridiculous. I had a call back with in a day and an apology that I had gotten lost in the system.  I received a large check five days later. I felt like I won a damn war.

The Ridiculous Process

In the end, I called them 44 times. I left 44 voicemails. I spoke with a human 15 times. I faxed documents three times. And no, I don’t have convenient access to a fax machine. I printed every pay stub for the past year and scanned and emailed them to a secure inbox. Which was so secure I had to create a new password every single time I logged in. And my emails conveniently got lost twice in the virtual world and I had to resend a total of three times. I worked with six different women. I called my health insurance twice. I called Medical Assistance twice.

I turned into an absolutely crazy lunatic. I figured at the end of the 6 months I had 50 hours into this damn thing. My point. Don’t give up. I almost did so many times. But in the end, the reimbursement I received was SUBSTANTIAL. And worth it.

And no, I have no idea what I am supposed to do going forward. And no, I have no desire to call anytime soon.

My point…if you live in the state of Minnesota and your child is on Medical Assistance AND you have them covered on your health insurance…call and see if you qualify for reimbursement. Good luck and God Speed.

 

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  • Jessicka Virgin

    June 5, 2017 at 1:18 pm
    Reply

    Your one hell of a Mom for that amazing boy! God your story sounds so familiar your frustrations of hitting brick walls in every corner. […] Read MoreYour one hell of a Mom for that amazing boy! God your story sounds so familiar your frustrations of hitting brick walls in every corner. I know that all to well sadly. Your a fighter and so am I! I love what your doing and sharing with so many ppl! Just special thanks to u 🙏Have great day Read Less

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Hi, I'm Kate. I am the mother to a little boy with severe, nonverbal Autism. This is a glimpse into our heartwarming, sad, scary, funny, loving and secret world. Check out my video tab to hear me ramble about Autism.

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