Tricare’s Lies, Greed, Autism Awareness and You

Autistic ChildrenI’ve been told several times to not bring this subject up, as if speaking out against a major corporation is hazardous to my health. Maybe it is, but I’ve never been the type of person to back down from a fight. Not a fight in which I might be at fault, such as when I was a teenager, and certainly not when I know I’m right. I’m pretty sure I’m in the right this time around, but why don’t you be the judge after hearing what I have to say.

I’ve posted at least one personal, highly opinionated article on the subject of TRICARE (The Bloated Conglomerate Insurance Company responsible for nearly everyone working in, for, and with the US Military)  in the past, and received a tremendous amount of support in response from my blog followers, several writers and even a couple of reporters. This far exceeded my wildest expectations. More importantly, it seems like TRICARE itself noticed.

At least for a few weeks.

To refresh your memory, here is a general summary of what my problem with TRICARE was and still is about. My fiancée, who I hope to marry sometime this year, has worked as a developmental disabilities teacher for about a decade. She has battled against overwhelming odds to help children with Autism and other learning disorders become self-sufficient, capable individuals. TRICARE makes it out to seem like it’s doing everything it can to help those responsible for giving these kids a better life, but in reality is doing everything it POSSIBLY can to deny those hopes and dreams. Here’s why.

If you want the 1% of children age 3-17 in the United States, or somewhere between 1 and 1.5 million people, to live a complete and reasonably satisfying life, you definitely don’t sneak around behind the backs of the extremely specialized workforce involved in the ABA process (That’s short for Applied Behavior Analysis), cutting funding here and there, refusing to pay for treatment, and otherwise making earning a living near-impossible for them. That’s just plain fucked up and wrong, especially when you claim to do the opposite.

Many people don’t know this but many of these ABA therapists are being run out of the business in recent years. This when many high-ranking officials in the military and/or just in general are working hand in hand with numerous charities and benefits to raise money to increase “Autism Awareness.” I can only speak from personal experience but the friends and family members of everyone I’ve talked to who work in the field can all vouch for one thing:

TRICARE is refusing payment for ABA therapy, for whatever reason.

Currently, TRICARE owes my fiancée several months of payment. The case manager, some fat, lazy PoS bitch named LaTrice (spelling? I’m not sure) has repeatedly messed up some authorization letters (putting in the wrong authorization dates, delay in putting out the authorization letter, putting in the wrong CPT code) and since there is really nobody above her, she can basically tell our family to kick rocks. There is nobody making sure those intentional “mistakes” were not reoccuring and no one is making sure that Tricare pays us anything, and because of this we have went several weeks at a time without ANY paycheck at all. Oh, and then when a paycheck finally does come in the mail, it’s for some random piddling amount, as if $300 is going to make everything alright when just our rent and utilities come out to $2000!? Pretty frustrating for anyone, don’t you think?

So after calling different departments over at TRICARE repeatedly for many months, we finally get an answer. According to some corporate PR representative, “Changes have been made, effective a long f_ _ king time ago.” I say this with the utmost snarling sarcasm. BTW, this is without any statement in the mail, or phone call letting us know what changes or when. No emails, effective immediately. According to my fiancée, there has been a change in CPT codes accepted so all of her previous claims are denied. Months of claims have to be resubmitted with another CPT code. It’s just TriCare’s tactic to refuse and/or delay payments to the therapists. Also, BCaBAs (bachelor degree board certified therapists) aren’t even getting paid, PERIOD! However, BCBAs (Master’s level board certified therapists) have not been cut yet. Why would BCaBAs been cut from the program if they are board certified? We can understand that non board certified therapists are not covered. For those like her who have worked their tails off to do something they think will make the world even a little better, people who put all their eggs in the therapy basket, there is nothing we can do but hope and wait that maybe with a ton of prayer, the insurance company might gift her with a paycheck this week.

But enough about the past. Let’s talk about the future of Autism Awareness.

Does anyone feel like the men and women who fight for our country, both at home and abroad, deserve for their disabled children to have treatment denied just because TRICARE is dealing with a lawsuit worth several billion dollars and now just doesn’t feel like it? It’s not our fault that you didn’t take better care of personal information.  It may seem like not a big deal to you, but for us normal Americans with normal jobs, waiting for $10,000 in claims to get paid out can mean the difference between being able to take care of our child and struggling to not max out our credit cards in the meanwhile.

This is where I formally put in a request for help. Neither of us has the time or experience to settle things with TRICARE through filing a lawsuit. We’ve tried calling and emailing any number of officials and corporate employees and it doesn’t seem like anything is getting through. The thing that infuriates me the most, however, is their public stance on therapy:

http://tricare.mil/CoveredServices/BenefitUpdates/Archives/AutismDemo.aspx

Just by reading that, it would seem like everything is hunky dory over here, when in reality nothing could be farther from the truth. How can you claim your furthering the cause of Autism Awareness, or any other learning disability research when even the insurance company of our armed forces is directly and indirectly responsible for numerous “paraprofessionals” exiting the industry? I’ll give you an example so you can better understand the hypocrisy:

The NBA is responsible for paying professional basketball players. If all of a sudden they refused to pay their players, most of them would be forced to quit and do something else for a living instead. When players can no longer make a living by playing basketball, people who would otherwise be learning to play basketball as a child or a teenager with dreams of going pro will decide to go into some other field, perhaps playing football in the NFL or hockey in the NHL.

This is EXACTLY what TRICARE is doing to the highly specialized field of ABA therapy. Nobody is going to get into a field where their star players (board-certified therapists) are treated badly. Would you want to play in the NBA if you couldn’t even pay your rent or put food on the table? Definitely not. The same kids who could grow up to find the cure for Autism, Asperger Syndrome, or Dyslexia if given the right motivation will almost certainly find something else to do that will pay the bills. Hopefully you understand my long-winded example.

If only there was somebody who could understand the gravitas of my situation, like say, Joe Mantegna, aka. Agent Rossi.

I know there is a high probability that someone as important as Mr. Mantegna will never see this article. Even if he were to see this little rant, or if someone mentioned it to him, I have little hope that he would ever respond. Regardless, if he ever were to read this or give me the chance to explain my situation to him, this is what I would say:

“Dear Mr. Mantegna,

I’m a big fan of your character on Criminal Minds, relative and important to me since it might be the only show my mom and I watch at the same time. The other day while I was partially watching an episode while at the same time reading a magazine, I heard your voice and thought it sounded almost like the funny cartoon mob boss on the Simpsons. Anyways, I saw one of your commercials the other day. This one:

At the beginning of your commercial, you say something compelling and instantly relatable. “In order to reach their full potential, children with special needs such as Down’s Syndrome, Autism, Cerebral Palsy, and other developmental disabilities need love, attention, and an education.. just like everyone else.” This sentence stood out to me since I’m currently struggling to understand why my fiancée continues to help military children. I’ve personally seen the good that ABA can do, but don’t know how we can continue if we don’t figure out a way to deal with TRICARE. If the teachers, researchers, therapists, and other educators don’t get paid, pretty soon they will leave the field. Hopefully someone like yourself could raise awareness to the situation, before it becomes untenable. It would be a shame if she could no longer do what she loves to do, working with special needs children, purely for financial reasons. I know that you have a personal interest in the Autism Awareness campaign and hope that you met plenty of wonderful teachers who helped your daughter Mia.

Thanks for taking the time to listen to my self-righteous speech. I know it only affects me indirectly, but I’d like to think I’m the type of person who can use my writing skills to help others. Even if my perspective’s colored, I feel like something needs to be said and/or done to help all the BCBAs and BCABAs affected.”

I gladly await all responses, especially one in particular.

~Michael

reach me at Wong_83@Hotmail.com OR leave a comment at Kyarnboy.Wordpress.com 

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The END of Autism Awareness

Are you one of those people who feel a twinge of sympathy when you read/hear about a story on the news about mentally handicapped children? I know I am. I’m constantly seeing commercials on late-night television about the miracles being performed on kids born with some form of genetic trait, struggling to handle a spoon in their cereal. I read about celebrities in gossip magazines… well, I hear about people reading gossip magazines filled with stories about this or that charity supporting people with disabilities. Cancer-research, Leukemia, Down’s Syndrome, Asperger’s Disease, Cerebral Palsy, etc., the list could go on forever.

The point I’m trying to get at is wouldn’t it make you extremely mad to know that people in your own country are trying to cheat the people who teach these handicapped children how to read, write, eat, put on clothes and even just communicate with their parents?

Well that’s exactly what’s going on now. At this very moment, a large majority of the insurance companies supposed to pay for these extremely specialized special-needs teachers are doing exactly the opposite. They take your insurance premiums and are happy to do so, but when it comes time to pay the teachers, they are making up dozens of excuses or reasons why they shouldn’t have to pay them. Does that sound fair?  It’s not like this is the easiest job in the world. Trust me, you and I are not as patient, kind, caring, understanding, constantly frustrated and under-valued as these people are. How do I know this? Maybe your asking yourself, in what way is this author qualified to speak on the subject?

To put it bluntly, my fiancée is a Board-Certified Behavior Analyst (ABA therapist). Her name is Joyce, and she is currently one of the foremost experts on children with learning disorders. She has lived and worked in the Maryland/Virginia area( GO DMV!) for basically her entire life, and above all else, gets barely any credit at all for doing a tremendous service to humanity.

If you’re imagining an overweight, middle-aged, primary-school special-ed teacher, you’re not even close to getting it right. She has multiple degree’s in psychology, sociology, child psychology, as well as master’s degrees specializing in behavioral science/early mental development. She was the dorky asian girl in the front of the classroom with straight A’s and a too-big pair of glasses, destined for scientific research. She has published countless papers, has apprenticed dozens of other board-certified therapists, and generally speaking, is the first person I would EVER think of calling if my kid had a learning disability.

She is also being ripped off, so to speak. The worst thing about this whole situation is that this isn’t just some random third-rate insurance company we’re talking about here. She works as an independent contractor for TriCare, aka: the Insurance company that provides for most members of the US Military. We’re talking every branch of the US Armed Services. These are the men and women of our country that are out there everyday, protecting our country from threats both domestic and foreign. Think about it, these brave soldiers and their loyal families will soon be unable to find anyone to take care of their mentally handicapped children.

They wont find anybody because of the hush-hush, recently-adopted policy of TriCare to continually refuse payment to special-needs therapists/educators. This is how it usually works: A potential client with some form of insurance looks online or gets a referral to her by other means. This family calls Joyce and asks if she has any time slot available to help their child/children. Depending on whether or not their insurance covers special-needs education/learning disabilities education, they either have to pay a small co-pay, just like going to the dentist/doctor, or completely out-of-pocket. The cost of these sessions can cost between 100-300 dollars an hour or more, depending on their reputation, experience and level of education or certification.

Depending on the child’s ability to learn, most of these teachers insist on between 5-10 hours a week at minimum. Ask yourself, how many people do you know that can afford to pay that amount of money on their own? Without the help of a “respectable” insurance company, very few people can afford to pay hundreds or thousands of dollars a week on top of their other necessary bills. Children with developmental disabilities CANNOT be cured, regardless of any drugs, surgery or any other modern forms of medicine. The only treatment with proven empirical results is Applied Behavior Analysis, otherwise known as Behavior Therapy.

If insurance companies such as TriCare, United Healthcare and Cigna refuse to pay for ABA therapy, claiming it isn’t a medical necessity, these children with developmental disabilities have a 0% chance of becoming a fully functional individual, capable of independent-living. The goal of all behavioral analysts is to integrate their patients into society, improving the quality of life for their families and teaching them critical life skills. In return for all this hard-work, TriCare has chosen instead to cancel ALL BCaBA(Bachelor-level Behavior Analysts). They have not cut out all BCBA(Master-level Behavior Analysts) work-compensation yet, but they have already begun to delay, deny, or refuse their weekly payments.

For the past 6 months, TriCare has accepted and verified Joyce’s weekly sessions, authorizing her claims and yet refused to pay her out except in the most minimal increments. Their claim is that they have to do “further research” on what is ABA therapy, choosing instead to have them starve, or suffer for no reason whatsoever. Remember that they are still collecting insurance premiums this entire time. Just for example, a colleague of her’s was held without a single payment for 6 whole CONSECUTIVE months! She still contracts part-time for TriCare, but is now forced to take on private clients or risk total financial collapse.

So what good reason could these insurance companies have for refusing to pay these honest, hard-working people? In my opinion, they are just making excuses so that they can line their own pockets. The economy is bad for everyone, but even worse for these analysts who are barely getting paid at all. For all the research, all the success stories, all the good-natured charities working to further the cause…

Nothing, absolutely nothing, is more damaging or damning to Autism Awareness, or developmental disabilities in general, than refusing to pay the researchers and analysts in the field. Hopefully something is done soon, before the US falls behind in yet another category, due to corporate greed, deception and lies.

Usually at this time of the year, my fiancée would be thinking about what presents to buy for her clients and where she would be going for the holidays. This year she has to worry about anxiety-issues, trouble sleeping, and how she’s going to pay the bills. All we can do is hope and pray that my paycheck and her leftover savings will be enough to pay the rent this month. Things would probably be different if a TriCare official had a child with Autism.

Wong_83@Hotmail.com