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.