What Health Reform Means To Me

G does not have a medial diagnosis of autism.  Thus far, we’ve gotten by with only an educational diagnosis.  We’re in a fantastic school system that never skimped on services or accommodations while the team that served the area got trained and certified in administering the ADOS.  When the ADOS results came back indicating G was on the spectrum, the school accepted the results without argument and have always worked toward what was best for G.  Since we don’t believe that G needs medication at this time, and aren’t the sort to experiment without evidence that a treatment will work, we decided we didn’t need the medical diagnosis.

A large motivator in not getting that diagnosis was our insurance coverage.  We’re self-insured.  G has another condition, Beckwith-Wiedemann Syndrome, which means he needs 4 ultrasounds each year until he’s 8 to watch for kidney and liver tumors.  Those ultrasounds aren’t covered by our insurance, so each year we pay $1500 out-of-pocket until we hit G’s deductible.  We’re fortunate that we can afford this expense.  But we worried that adding another label to G’s medical history would either cause our rates to increase or our coverage to be cancelled.  So we made the decision to avoid the medical diagnosis, to the point where I was always nervous to tell doctors at well child visits that G is autistic, worried they’d write it into his chart and the insurance company would find out.

This is why I am so happy health reform was signed into law today.  I feel safer now.  I feel like I can take G for a medical diagnosis any time now without worrying that it would prevent him from ever getting insurance coverage again.  I feel like we can be honest with our doctors.  I feel the weight of secrecy has been lifted from my shoulders.  I’m even wondering if his ultrasounds will be covered now. 

That might be pushing it.  😉

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Published in: on March 23, 2010 at 1:08 pm  Comments (2)  

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2 CommentsLeave a comment

  1. You might still be able to get by without a medical diagnosis – unless you want one, that is. A medical diagnosis of autism does not guarantee the school has to give services anymore. A child can still not qualify for services even with a diagnosis. It’s tricky, this medical vs. educational diagnosis thing.

    I agree about the coverage – Neither C nor I would qualify for private insurance until now. Husband has always had to have a job where group insurance is offered. We’ll likely still go that route, but it feels as though a little bit of the pressure will be off now! Whew!

  2. You know, I’ve heard about schools refusing to accept medical diagnosis’, which is another reason we’ve been satisfied with our educational diagnosis. We’re pretty content to maintain the status quo, I’m just more comfortable now that it’s our choice and not something we’re doing because we’re afraid of the insurance company.


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