Monday, August 09, 2010


We are experiencing some fun times with our health insurance right now. And by "fun" I really mean "frustrating and aggravating". Without going into all the details, what's basically been happening is that we're having a hard time getting our insurance to cover any of the cost of the ABM therapy. Avery's PCP did a peer to peer review for us, but that didn't change their decision to not cover it, so now I am waiting on some appeals forms that have supposedly been mailed to me so that I can file an appeal myself. *sigh* So we're probably not going to be able to take Avery back up to see Carla until at least October.
In the meantime, after several weeks of discussion with Avery's wonderful PT Lisa, we have decided to stop taking her to physical therapy alltogether. At least for now. It's a little scary. But we really feel that we need to give ABM therapy a proper chance, and after Lisa and Carla spoke for about 45 minutes on the phone, it just seems as though the traditional PT isn't really compatible with ABM at this point, since all of Avery's goals in regular PT focus on getting her walking, and ABM takes a few steps back and works on pre-walking stuff. It also means that Avery will not be able to participate in hippotherapy, which she was supposed to be starting in a couple of weeks.
We have been approved to start back up with the occupational therapy, which we feel will be helpful since it seems to work a lot on the confidence building which seems to be so helpful for Avery. However, there is a waiting list for OT, so we don't know when we'll be able to start back up with that.
Also, we still don't want to send Avery back to school in September. At least, not the way they want her to go. They want her there 6 hours a day, 5 days a week, and there is no way we are agreeing to that, and they know we're not happy about it, but are still hoping that we'll agree to try it, but we won't. Avery does not have the energy or stamina of other 4 yr olds, and 6 hours of school every day would mean that she would not be able to do anything else besides school. No PT, no OT, no pool time, no nothing - just school. And her in-school physical therapy is being cut back to 30 minutes every 2 weeks. And since we're certainly not sending her for the academic aspect (most of her reading/writing/math learning is being done at home anyway - as I've mentioned before, most of her classmates are in the special class for cognitive/verbal/behavioural delays), what we know as her parents is that full-time preschool is not in her best interest at this time.
So to summarise so far - NO Anat Baniel Method therapy, NO physical therapy, NO hippotherapy, NO occupational therapy and NO school.
Here's what we're aiming for:
  • Get the ABM therapy approved by our insurance. If we can achieve this, then we will aim to take Avery up to Sterling, VA once a month for several sessions over the course of a couple or days.
  • Have a meeting with Avery's school team to change her IEP to reflect the new goals we have for her. Put her in school for one, maybe, MAYBE two days a week, and hopefully at a different school.
  • Get a wheelchair through Avery's school therapist. We spoke to Lisa about this, because of course right now, Avery is still wanting to walk a lot, but she is doing it with her walker, which is just awful for her. Definitely does more harm than good. So while we don't want to take it away, we don't want her using it for distances, but we would still like for her to be able to enjoy some independence. So a wheelchair which she could propel by herself would allow her the independence she loves without the problems the posterior walker presents. Of course, she would need training to learn how to use it properly, etc.
It seems odd to be where we are right now. And I know it seems like taking several steps backwards to be cutting back on the walking front. We aren't making Avery wear AFOs, and we don't make her use her quad cane anymore, and we encourage her to sit in the stroller when we go out instead of pushing her to walk. But, it seems to me that we need to pursue the ABM therapy because the whole philosophy of it makes absolute sense to me. And with all the "in between" milestones we've seen in her since starting ABM, I just feel that it's important for us to at least give it a serious trial for several months. It's just frustrating that right now that means that we have to stop everything while we try to get our insurance on board.
I'll leave you with a little video of yet another of Avery's accomplishments! She's been doing this for about 2 weeks.


Carla said...

YAY for Avery! Roly Polys are awesome:)
Boo to insurance company!
I'm with you on the school subject, I want my little guy to go but not for as long as they want him to go. What is with these school people?

Jolene said...

Wow what a great roll over:)

Anonymous said...

If your ABM person is a PT you might be able to bill the ABM as PT. Still - lots of cooperation from the ABM center, the physician and the insurance co to okay the 'intensive' dosage. I don't know of any circumstance where healthcare insurance paid for ABM billed as ABM.

The balance between independence and waiting for development is a tough one. Barbara