Searching for answers

Early intervention strategies are imperative for individuals on the autism spectrum.  By developing strategies and implementing therapies and systems, an individual on the spectrum can lead a very productive life.  The key is starting these therapies in the early stages following a diagnosis.

As I wrote about here, the cost of caring for someone on the spectrum is high, even when spread over their lifetime.  23 states have mandatory coverage laws in place to cover patients on the spectrum.*  Florida is one of those states.

The more we learn about Kaitlyn, the more we understand that she will need to begin therapy in the near future to help her maximize her life.  In Tallahassee, there is a place, Progressive Pediatric, that comes highly recommended by several friends.  Progressive Pediatric provides services for a wide variety of individuals..those with autism, cerebal palsy, Down’s, pretty much anybody is welcome to receive services there.  Because of the wide variety of services they offer, Progressive comes with a pretty nice price-tag, and it is our understanding that they are worth every dollar (so this is not going to be an entry critical of their cost), and we are strongly leaning toward using them.  While talking with their founder Tammy at the Autism Run a few weeks ago, the subject of insurance coverage came up, and Tammy expressed that they do accept insurance, however, they have been unable to be listed as a provider for the Big Bend’s largest provider, Capital Health Plan.  That struck me as odd, but not as odd as the reason why they are not listed as a provider:  CHP basically told them that there are already too many similar service providers.  Interesting.

Being an inquisitive person, and not one to just blindly accept an answer, I decided to do some research.  I picked up the phone and called the member services line for CHP, and my call was answered by a very nice lady.  I explained our situation to her, and our desire to take Kaitlyn to Progressive.  She listened and came back with the same response that Tammy had received…too many similar providers.  At this point, it was time for my opinion to be heard.  I stumped the lady with my comparison of “too many service providers” to having too many doctors that provide the same type of service.  After some awkward silence, she did inform me that I could petition to send Kaitlyn to Progressive, and after a 14 day review, I would have an answer…basically, I was told that I could ask, but there was no guarantee that we would be approved. 

I was still curious about there being “too many similar providers,” so I searched the CHP online provider directory.  Now you might be thinking that I found a dozen or so providers of these helpful therapies, but you would be wrong.  I found two.  That is not a typo, I found two, as in the number between one and three.  I am dumbfounded as to how two can be “too many similar providers.”  Does anyone care to explain that to me?  CHP did not have an answer.

*The list of states with insurance laws can be found here.


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