This was the first week of summer camp for Noah. We have all been very excited for him to go to the camp he's attending. They came well recommended and willing to work with us with Noah's issues and his Therapeutic Staff Support (TSS) (part of his wraparound services). We visited the camp last summer and we were impressed. Finally, an easy decision for us to make. A great camp with all the activities Noah loves, a guarantee he would come home tired every night, and the camp is only five minutes from our house!
Although deciding what he was going to do this summer was easy, I spent most of the school year worried we wouldn't have a TSS for him either because the insurance company wouldn't approve it or the agency we work with wouldn't have one available for the hours we needed.
I don't think I blogged about the struggles we had this year getting a TSS for Noah for his afterschool program. The first part of the year we were trying to change agencies to one that was closer to his school. So Noah had only occasional TSS coverage prior to January. In January we found a new agency but it took a while for them to find the right TSS for him. It took four TSS's before we were matched up with M, who has been with him since April.
M has been amazing with Noah. She does far more with him than any other TSS he has had. She see's his potential and is really an advocate for him. We've been thrilled with her. And she wanted to stay with Noah for the summer and go to camp with him! Yeah! Another hurdle down!
Now all we needed to do was get his hours approved with the insurance company. The insurance company that has pretty much fought us since we first tried to get him wrap around services when he was 2 1/2. The insurance company that we had to go through multiple grievance procedures with before they approved him.
Take make a long, boring story slightly shorter, the agency we are working with could send in the paper work requesting camp hours 60 days prior to the start of camp. I had been talking to them about this since December when I first met with his case worker prior to bringing them on board.
Approximately six weeks before the start of camp they told me he needed an updated visit with their psychiatrist. And then they asked for a letter from camp stating they required him to have a TSS. Then I had to sign more paper work. So just over three weeks until the start of camp I was told his paperwork was submitted. It was our understanding the insurance company had three days to give us a response.
So a week after I was lead to believe the paper work had been submitted I received a call that the insurance company was requiring an inter-agency meeting with the camp, which they would attend. We scheduled a meeting for the next day between the camp owner, Noah's Behavior Specialist Consultant (BSC), me, and someone from the insurance company.
It was 2 1/2 weeks (a Wednesday) before the start of camp and it wasn't looking very good, especially after the inter-agency meeting, where the insurance rep basically told us that no one was ever approved for the number of hours we were requesting (full time) and that basically that was one step before residential treatment. She told us realistically he would probably be approved for ten to fifteen hours.
To say I was freaking out at this point is putting it mildly. I had no idea what we were going to do if he didn't get approved for the hours, because he couldn't attend camp without the TSS. And I had no control at this point about how the paper work was being submitted or what was in any of the reports. All I had was confidence in P his BSC that she was doing all she could to make this happen.
P told me that she went over all the paperwork with Noah's case manager with the agency and it was submitted on Friday. We should know something by the middle of the next week.
So we waited. Wednesday came along and there was no word. Thursday came along and there was no word. I talked with P and she told me the case manager was on vacation that week so she was going to have the assistant check in with the insurance company Friday morning.
By then, ten days before the start of camp, I wasn't going to rely on someone else to get me an answer. So I had Rich call the insurance company to find out when the paperwork was submitted and exactly how long they had to give us an answer.
Well, imagine my surprise when they told Rich that the paperwork hadn't been submitted yet! So I told Rich to call the agency and find out what had happened. Which he did, and received some pathetic excuses. So I had him call back and ask for the head of the agency. At this point the head of the agency was making all kinds of promises about personally delivering the paperwork. And I was on the phone with P, who was PISSED when she found out about the paperwork. And then I was on the phone with T at the insurance company who was telling me we had plenty of time because his camp didn't start for over a week. To which I responded "wtf! if you don't approve him I'm screwed. How am I going to find another placement for him with just a week?" OK, I used less swear words, but I think I got my point across. T promised to call me Monday when he reviewed the paperwork to let me know if anything was missing. He wouldn't come right out and say Noah was going to be approved, but he did alleviate some of my anxiety so I wasn't completely freaked out over the weekend.
So, Monday comes along. One week before the start of camp, and Noah's last week of school. All day I'm waiting for a phone call from someone. Mid afternoon I pretty much said fuck this being patient bit and called the agency to speak with his case manager. I'm guessing she caught hell that morning when she came in to work because she was very accommodating and said she would call T at the insurance company right away.
About fifteen minutes later she called me to say Noah was approved for all the hours we requested!
I think we were all a little shocked! But Yeah! A huge relief! We had a camp, a TSS we completely trust and insurance approval. Let the summer begin!