Aurora Borealis

I don’t think insurance companies should be demonized the way the Democrats have been doing; but they indeed have their problems and can be very annoying and short-sighted.

Agent Murphy had his regular speech therapy on Monday.  After we got home, the CHOA location we go to contacted us to tell us they had just been informed by Aetna that all the visits since the beginning of February are being denied.  Mind you, the therapy site contacted Aetna sometime in December to re-verify benefits for 2010 and were told everything is fine and we’re covered for 60 visits per calendar year.  He’s had maybe 13 so far in 2010.  And all the appointments in January processed normally.  By the time I spoke with the insurance specialist, Candy, at the therapy office, she told me our therapist was already going to war pulling together information on medical necessity.  She was drafting a letting about it which she was going to get over to our pediatrician’s office so they can sign off on it too.

Candy asked me to call Aetna to find out what I could from my end while they start the appeal process.  I spoke with Lisa C. at Aetna, who informed me that after some number of visits billed under the same treatment code, they want additional information to find out if the treatment will bring the patient to a “restorative state” before they continue to pay.  She said I was in a good position if the provider was going to go to bat on the Agent’s behalf, because they’ll have all the medical documentation Aetna is looking for.  Her sense was that when they have the documentation they’ll go back and pick up all the denied claims and reevaluate them.

Well, okay, wanting to know if a course of treatment is effective rather than futile makes sense.  But is denying coverage to force an appeal the only way we can accomplish that?  How about a simple request to provide certain medical documentation by a certain date, after which treatment won’t be covered until the documentation is provided?  No, no.  We can’t do anything so reasonable.  Just deny the claims.  And interrupt the treatment.  (Unfortunately, Candy was out sick today so I couldn’t talk to her about whether we should keep proceeding with his visits normally or suspend them until this is resolved; so the person I did speak with suggested that it was best to be safe and cancel tomorrow’s appointment and then get better guidance from Candy when she’s back.  Fact is, if they’re going to end up denying coverage in spite of the documentation, we can’t afford to be on the hook for more than we already are; even on the covered visits, we’ve still paid a pretty penny.)  Of course, we’ve just started gaining some momentum since introducing the communications book and device.  And I hope this interruption doesn’t mess that up.  Fabulous, right?  We’re not sure if this treatment is effective enough, so we’re going to interrupt it and make it less effective.  Stupid, stupid, stupid.

Anyway, we did get our communications book from Miss Lindsay on Monday and we need to start using that at home.  (We need to make braille labels on it for Daddy, too.)  The plan is to primarily use the book at home and the device (the loaner) in therapy.  Yesterday Agent Murphy did really well using the device.  And he’s even trying to say the word himself when he pushes the appropriate picture.  Miss Lindsay’s theory is that with the device as back up, he’s less frustrated about not being able to make all the sounds so he’s more willing to try them.

So we’ve recently had a couple of opportunities to socialize with friends – first old, then new.

Monday night we had dinner at the B.’s house.  G. and A. and their 2 kids were in town from Alabama because G. had a work-related week-long training. So it was a big gathering and nice to see everyone.  The kiddos seemed to have fun together.  J. looks just like G. and M. has A.’s wonderful red hair.  Many thanks to Aunty N. for putting the evening together and including us.

This morning after Mass we were finally able to take Jerry up on his offer to take us to breakfast.  He invited us I think our first time attending Mass at All Saints, but we were in the throes of packing and preparing for the move then.  And then Mr. Tldz was in the Fathers for Good class after Mass for a number of weeks.  And then we didn’t see Jerry for a number of weeks and we thought he’d given up on us.  So it was good to be able to accept his generous offer today.  There were 8 of us at breakfast — a nice time.

Today Agent Murphy went for an AAC evaluation because he’s been at something of an impasse in his speech therapy lately.  He won’t consistently use the signs he knows, he won’t consistently even try to imitate sounds (let alone get the right ones), so his speech therapist wanted the AAC specialist to evaluate him to determine if there’s anything else that might help him communicate while we keep working on speech.

Today’s therapist agreed with us that he understands a lot.  She said when she sees such a big gap between comprehension and expression, she expects there’s something oral-motor going on.  She agrees with our speech therapist’s unofficial diagnosis of apraxia — an inability to make a particular sound on cue.  Apparently it’s something you might see in adults who’ve had a stroke.  They can make all sorts of sounds and say lots of words, but if you say something to them like, “Say ‘mother’” they struggle and think really hard and can’t say it.  And then an hour later they’ll just blurt out “Mother.”

An occupational therapist observed his session today, too, and she said she thinks he might have slightly low tone in his facial muscles; but nothing that seems to require intervention now.  We’re just supposed to keep working with him on imitating sounds and such.

And we’re going to work on putting together a communications book for him — pictures of various things in different categories that he can use to communicate.  They also loaned us a basic communications device to see if he’ll get passed the stage of “let’s just push all the buttons” and actually consider using it more reliably to communicate.  Her preference, like mine, is to stay pretty low-tech with assistive stuff at this point, given that he’s still pretty young and hopefully will start vocalizing more.  (Of course, he vocalizes much more at home than he ever does in therapy; but it’s all still pretty random.  Although he does seem to be learning to say “No” — like when we tell him he has time out — though it’s a bit more like “Nuh.”)

We’re supposed to see the AAC specialist again in about 6 months to see where we are and if we need to change course.

So on Saturday night Mr. Tldz and I had a big night out — or at least what passes for a big night out around here.  A Catholic parish about 30 miles from here brought in Joy and Jim Pinto of EWTN fame (so we’d never heard of them!) to do a mission evening talking about marriage.  He was raised Catholic, became an Episcopal minister, and then in 2003 he and his wife came into communion with the Catholic Church.  He’s now a pastoral associate with Priests for Life and she is the executive director of a CPC in Alabama, in addition to their radio show, television appearances, and various speaking engagements.

They had lots of interesting things to say, and clearly they typically do longer missions of 2 or 3 days.  They condensed that into about 2 hours, so it was really something of a highlight reel.  I bet they’d be worth seeing in a lengthier format.

Anyway, the parish provided childcare in the church nursery and dinner (heavy hors d’oeuvres, really, but it sufficed) for the mission attendees.  So it was a full service evening for the bargain price of some gasoline.  Good times.

Agent Murphy was the youngest kiddo in the nursery and apparently had a great time.  (He always seems to like the nursery of whatever parish.)  Fortunately for him, unlike the other parents, his parents thought to pack him a dinner so he wasn’t starving.  It was a late bedtime for him, but he’s back to his normal sleeping now.

We are excited (though terror may be the better word for what I’m feeling) to announce that Garbanzo Bean III is expected to join our family around July 25.  Yes, the third.  That’s not a typo.  There was, briefly, a Garbanzo Bean II (now known as our Agent Raindrop), but I miscarried back in February at only 8 weeks, before almost anyone even knew I was pregnant.

So we’ve been rather cautious about saying anything about the new bean.  My gynecologist managed the beginning of this pregnancy very carefully. I just saw the OB for the first time today.  He had a hard time finding the heartbeat with the doppler.  He thought he heard it faintly in the background, but he wasn’t sure; so we got to have an unofficial ultrasound and saw the heartbeat and an active little baby.  Even with having seen that, I still have no sense of who this one is.  With Agent Murphy we pretty quickly felt the baby was likely a boy, and we were convinced pretty much right off the bat that Agent Raindrop was our little girl; but so far no feeling about this one.

I have an “official” ultrasound next week to confirm or modify the due date and then my next appointment with the OB 4 weeks from today.  Here we go!

So it turns out Mr. Tldz will be going into the office every day this week and next week, too.  At least there’s the holiday on Monday!  He’s been very busy. He didn’t get home until 7:30 Monday or last night, and Monday night a co-worker of his came over in the evening and they worked some more, from about 8:30 until almost 10:00. His boss says he’ll be able to catch the 5:20 bus tonight so he can get home in time for me to go to the MOMS Club book club meeting. It seems like they’re getting a lot done, so hopefully things will settle down a bit after these two weeks.

So I bought Agent Murphy a pair of slippers a month or so ago.  He really likes them.  They have lion faces on them.  For the last few days at least, he’s decided he must be tucked into bed wearing them.  Okay, well, that’s our boy.

So last week we started going to therapy twice a week for 30 minute sessions instead of 1 1-hour session each week.  Seems like that might work well for the Agent.  He can’t really focus for a full hour, so he’s actually getting more out of the sum of the two shorter sessions than the 1 session.  He’s starting to be more willing to vocalize some vowel sounds on command, but it’s a struggle for him and often he can’t get quite the right sound.  He tried real hard today, though.

The Agent seemed plenty tired this afternoon, and actually stayed in his bed for a while; but no sleep.  He got up, put on his own pants, socks, and slippers, and came out to find me.  He is wired and crazy.  Will have to work to keep him away from The Dog. Methinks an early bedtime for him tonight.

We’ve been to Mass this morning for the Feast of Mary, Mother of God.  It’s nice that All Saints offers a normal Sunday Mass schedule for today, so we went to our usual 8:45.  We were asked to bring the gifts up to the altar. Mr. Tldz carried the cruet of wine, I took the water, and Agent Murphy carried the sacramentary.  Once we got him pointed the right direction, he did pretty well.  When we got about half way up the aisle, Father Jude (the visiting Franciscan scholastic who teaches theology at a college outside of Philadelphia and who also said Christmas Eve Mass) knelt down to be at the Agent’s level. Then he really seemed to get it, and he raced the rest of the way up the aisle with the book.  Father Jude told him he did perfectly.

Now that we’re home, we’re back in our PJs and set for a lazy day. Diapers have been folded, the beginnings of a pot of soup is on the stove for dinner (lunch will just be Christmas leftovers), and now we’re ready to watch movies or something.

Last night we ordered in a couple of pizzas for dinner.  We were going to watch a movie after the Agent went to bed, but I’d been fighting a migraine all day, so we were curled up in bed with cups of spiced cider listening to the radio by 8:30.  Fell asleep sometime after that, and then woke up around 10:30 to go to bed for the night. A couple of old fuddy duddies, we. But I can’t really think of a nicer way to celebrate the new year. This morning we had cold pizza and egg nog for breakfast – what a way to start 2010!  (Okay, we were responsible parents and the Agent Murphy had his usual breakfast: oatmeal mixed with apple sauce and yogurt, a banana, a vitamin, milk.)

So now on with our lazy day.  Nowhere to go until church on Sunday morning. If only we could keep the Agent from pestering attacking The Dog…