The Insurance Blues

I have always expected that we would run into some insurance woes now and again but I had always figured that since we are very fortunate to have really good benefits from Ray's work with Whatcom County, that our troubles would be somewhat limited. Today we were in for quite a shock...even if we were expecting it sooner or later.

You see, Dylan receives numerous therapies which is common with special needs kids. Dylan goes to Occupational Therapy (OT) at St. Joseph Hospital as an outpatient. We also receive speech therapy and go to "school" through the Whatcom Center for Early Learning. At "school" we receive even more OT, Speech, and Physical Therapy. Dylan and I go for therapy weekly (sometimes 2 or 3 times a week) and this has been fundamental on how well Dylan is doing. It not only gives Dylan the tools to function somewhat "normally" in the present tense, but is VERY important to providing him with the skills to function well in society in the future.

We received a call by our Family Resource Coordinator (FRC) that we should probably look into our benefits regarding our outpatient therapies to make sure we weren't reaching our "limit." Being as naive as I can be, I figured that we were pretty well covered but said that I'd be happy to check. Boy! Am I glad Julee (the FRC) was on top of things!

I called our benefits counselor who informed me that we did in fact have a limit. BUT, she couldn't tell me what the limit was NOR where we were at to date on our benefit spending. She referred me to the customer service department. So...I hang up, redial....hold for 20 minutes. Then, I find out that our limit is $1500 per calendar year and we have already used a little more than 1/4 of that amount. I also found out that this does NOT include any billing by Whatcom Center for Early Learning but so far, only St. Joseph Hospital. So when WCEL does begin billing, we are looking at a very short time period before our benefits run out.

So what does all this mean? That is what I had to ask. You see, we now are burdened with finding a secondary insurance provider for Dylan which most likely will be through the state. This also means that I have now entered the bureacracy nightmare that I kept hearing about and felt so fortunate that I didn't think I would ever be in that position. To apply for secondary insurance through the state, it essentially means I apply for DSHS...yep, you are starting to get a hint of my pain. We then see if we qualify for medical coupons, then apply for HMO's, etc. The good news is that I will not be able to return to work anytime soon. It looks "better" to have only one income and it is also in our favor to be expecting another child.

That is just the tip of the iceberg. I am waiting for a call from Julee (the very kind FRC), who will help me get in touch with DSHS and hopefully, explain some of the process to me. I started having terms thrown at me, conditions, forms needed (all of which are labeled with numbers and letters....worse than the IRS), etc.

I already have a headache. I guess I deserve it for being so naive!