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.

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 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.

Our little shindig for Agent Murphy went well.  He seemed to really enjoy himself, and it was good to see some of our friends.  (We were shame-faced when we realized we hadn’t seen Aunty M. since The Agent’s first birthday party.  Yikes!)  And a new friend — Chef Knight from All Saints and his son G. (age 5) joined us, too.  G. was being shy, though.  He didn’t want cake or to blow bubbles.  At least he had some root beer.

The Agent, of course, was not shy about food.  He dug right into his piece of carrot cake, and tried to eat off the big cake plate.  He and Aunty M. and Aunty N. and A. went out on the deck and played with the bubble bucket from Uncle RW and Aunt S.  The Agent appears to have had a blast. I. slept through the party again, just like last year — but this time in The Agent’s bed instead of the playpen.

The Agent got some cool loot, too.  In addition to the bubble bucket, he got some really cute Christmas PJs and a children’s book about the real St. Nicholas from Uncle R. and family.  G. and his twin sister M. (who didn’t come to the party because she was arguing about what she could or couldn’t wear) got him a fun See-n-Speak, which is awesome because just the other day I was thinking that’s something we should get the Agent to help him with his sounds.  And Aunty N. and family got him a Play-Doh activity kit, which has him really fascinated.  Maybe we’ll dive into it tomorrow or one day this coming week.  Aunty N. always picks great presents, I guess because she has such good “product testers” to help her!

And we got to start a new page in our guestbook for our new house.

Definitely a happy birthday party.

Mmmm... carrot cake with cream cheese frosting!

Agent Murphy saw the pediatrician today.  He measured 37.25″ tall (still off the charts) and his weight is catching up with that height some at 32 pounds 6 ounces.  The doc is very pleased with his growth pattern.

Little guy was very good about going on the scale today, unlike last time.  And while he’s still freaked out by the crinkle paper, he tried very hard to be stoic.  He was upset after he had to lay on it to be measured, but when the nurse sat him up he was sniffling and practically biting his lip — very obviously trying not to cry.  He only cried when he got the two shots.  (Not even the toe prick to check for anemia seemed to bother him; his iron is fine, by the way.)

Oh, and the doc assured me he is too young to drop his nap and she thought it was a good idea to try confining him to the playpen to get him to nap.  Whew!

At the end of his appointment he got a special little bag to keep his treasures in.  He really seems to like it.  And now he gets to start a daily chewable (half) vitamin.  Our little boy is so big!

Hard to believe, but our little guy turned two yesterday!  We had a good day.  We went to story time at the library (the two-year-olds group!) and at the end everybody sang “Happy Birthday” to him.  He got a phone call from Grandma when we got home, and then during lunch, since Daddy was working from home, he got to open his presents.

He got a dress up doll we’ve named Zack, and a book of nursery rhymes with a sing-along CD.  Both seem to be hits.  Zack got dragged around everywhere, and now The Agent has decided he needs to wear Zack’s wristwatch.

In the afternoon The Agent made his regular trip to the mailbox with Daddy and found a birthday card from Grandma.  All in all a good day.

However, in the last week or two, The Agent has seemed pretty intent on NOT napping.  It still seems to me like he needs it, but he just refuses.  I’ve started putting him in the playpen for naps so he doesn’t have the option of getting up and playing, but he’s still not sleeping.  If he really drops the nap already, Mommy may have to run away from home!  For the last few days, since he wouldn’t nap, we’ve just started putting him to bed a little earlier.  We’ll see…

Oh, and I forgot to mention that on Monday, Agent Murphy figured out how to climb up onto his big boy bed by himself.  Hooray!  And over the weekend he started singing along to the Matlock theme.  (”Dah dah dah dah duh, dah dah dah dah duh…”)  Yeah, that’s our boy.

We had a little bit of progress today for the first time in what seems like a long time.  We tried food as a motivator, and surprise, surprise, that worked for our little guy!  He’d do lots of stuff to get another bite of Daddy’s homemade sourdough bread.  He’s still not vocalizing a whole lot for the therapist, though while they were playing with a wind-up puppy dog he did try panting like a dog when she did.  And he’s more willing to let her touch his hands to show him how to make different signs than he was before.  He learned the sign for “eat” really quickly today, and he kind of picked up “bread” and “block” today, too.  He’s more willing to look at me and immitate the signs I’m making than the therapist, which I guess is just fine since I’m with him all the time.

Maybe we will get to words one of these days.  It would be nice.

Today Agent Murphy had his second session with his new speech therapist.  (The first has switched to all in-patient work.)  This woman isn’t quite as bubbly.  And she has me sit in the observation room during the session, rather than in the room.  I don’t know that it makes any difference to the Agent, and it might be good because I’m getting frustrated; so it’s probably good I’m not in the room.  He’s hardly vocalized for her at all.  And he’s been really hyper and having a hard time focusing for her so far.  In part he may be a little discombobulated by all the packing at home.  Everything is changing.

We’re taking next week off for the move.  But then we’re scheduled for the next 6 weeks at a consistent time.  Hopefully we’ll start to see some progress.

With all the busyness of late, I forgot to note that on Friday night both of my men got haircuts.  Agent Murphy sat in a booster seat in the chair, all by himself instead of in a lap for the first time.  He did really well and we’re very proud of him.

It sure feels like it.

Princess Buyer (and her aunty, the other agent) needs to extend her due diligence period because she’s not sure the underwriting on her loan (where they officially say sewer doesn’t have to be connected) will be done in time, and without knowing that for sure, she’s still not sure “what to ask for” as far as repairs.  She wanted to extend it through next Wednesday (it’s supposed to end this Thursday).  Our agent called this morning and seemed to think that was reasonable and we should just agree.  I pitched a fit and pointed out we’d already given them a longer due diligence period (14 days) than the 10 we’d wanted.  I told her we’d give them through Monday (to which they agreed).  And then I told her to get some numbers from them.  They’ve been sitting with the inspection report and the plumber’s estimate on connecting to the sewer for over a week.  Certainly they should be able to give us at this point: IF sewer connection, THEN we want xxxxx.  IF NOT sewer connection, then we want yyyyy.  It sure is coming across to us that they plan to ask for a lot, and if that’s the case, we can’t do this deal and we’d rather know that sooner than later.

Still no word from the sellers of the house we’re trying to buy that they’ve made any progress on their bridge loan contingency.  Which may well mean we’ll have to push the closing date because we can’t even order an appraisal until after that is removed.  It feels like we’re the ones having to be flexible on both ends of this deal, and it feels like we’re going to get screwed.  And I want to know who the hell is representing our interests in all of this.  Because right now it feels like our realtors are doing a piss poor job.  We were really impressed with the activity they got on our house and were looking forward to recommending them to some folks; but now I’m not so sure about that.

And I’ve been in a truly foul mood about all of this all day.  It doesn’t help that Agent Murphy is being his usual annoying self and he had a fruitless speech therapy session (he went in short on napping because of the time of the appointment that was available; fortunately we now have a schedule set for September that doesn’t interfere with his normal nap schedule) which once again has me wondering if there’s any point to all the money we’re spending on this therapy.

Meanwhile I’m exhausted and sore from working in the basement all weekend trying to get us ready to move.  And I have another day of it planned tomorrow since our moving company delivered packing materials today.  At least that gives me a reason to ship the Agent off to a babysitter for the day.  But it will really suck if it turns out this deal falls through and we end up just taking the house off the market and living here, cramped and unhappy, until we die or pay off the mortgage, whichever comes first.