punchdrunkmom

Excuse me, but I was told that there'd be no math?

So the difference between two health insurance plans at Scott’s company is about $3900 a year. Not nothing, you know? One pays X, and the other pays less, it costs less but your deductible is higher, there’s a higher out-of-pocket. For all that I really, really care about what’s covered in the plan, it all starts to go all Charlie Brown’s teacher on me when we start crunching numbers.

We were advised to add up all of our expenses and determine which was the better plan.

No problem. I’ll just add up all of our expenses. And then calculate the percentages, and run them against the deductible and the out-of-pocket. Because you know what your expenses are, don’t you?

Don’t you?

:::

So Scott and I sat down to look at the plans and realize that we actually didn’t know what an out-of-pocket was. Turns out it’s a random amount of money that after you reach it, the insurance company pays out 100% of your claim.

Only they don’t because they don’t pay out the claim, they pay out what they think is a reasonable cost for that claim, and pay a percentage of that until you reach your out of pocket.

So, for example, a speech therapy session in Villa Park, Illinois is billed at $180, but the insurance company doesn’t think that’s reasonable. They think $50 is reasonable, and then they pay 70% of what they think is reasonable, which comes out to 35 dollars.

Because they’re jerks.

And also, I’m totally going to start doing that at the grocery store.

But no matter. Scott and I pulled out our iPhones and gamely started to add up expense: 2 OT sessions at $180 apiece, 2 speech sessions, one billed at $200 and one billed at $180. Social work with Miss Sue. Our neurologist. Our neuropsychologist. Our allergist.

X over 180 equals 80 over 100, carry the one minus deductible and the out-of-pocket. I started sweating when Scott started using the word “delta,” as in the delta between two numbers.

“None of these numbers make sense,” Scott said, finally. “This looks like they cover so much, but don’t I write checks for thousands of dollars?”

We thought about it for a while, and then remembered that we were on the hook for the $130 that the insurance company doesn’t think is reasonable. We grabbed our iPhones and started calculating new numbers.

“And how do you factor in the maxing of the out-of-pocket?” I asked, and was reminded that I barely scraped by in calculus with a D. I remember that one of the questions on the final began with the words, “A mad scientist wants to build a fence.” And I'm sorry, but a mad scientist's landscaping ideas shouldn't really be my problem

“Scott,” I said, an edge of panic in my voice, “these numbers shift and move.”

I pored over the brochure one more time, the one that HR kept referring to, the one that laid out various insurance scenarios, hoping some detail would jump out at me.

“So-and-so has three kids and expects his medical expenses to look like this,” was one example. But how did So-and-so know that all of his medical expenses would add up to $22,576? How on Earth would he know that? Was So-and-so a genius of some kind? Clairvoiant? A meticulous, savant Type-A record keeper? Were his kids robots? Were they neurotypical? I began to really hate So-and-so, who was clearly an asshole and trying to show how much better he was at raising children and running a household than I. On the other side of the table, Scott was still talking about deltas.

And so I added some stuff to the list of degrees I think you should run out and get after you get an autism diagnosis:

Law

MD

MBA

Psychiatry

Psychology

Education

Ninja

Accountant

Actuary

And then we threw a dart, chose a plan, promised to create a giant and detailed Excel spreadsheet for 2013, and turned on Homeland.

I never did find out what the delta was. But that Dana sure is freaking everywhere, isn't she?

 

 

 

In which I can be thankful without maximum benefit

I hope you guys had an awesome holiday. I did. I did exactly nothing to prepare.

Nothing, I tell you.

I didn’t have to cook, the kids were surprisingly well behaved and adorable. In fact, my holiday looked a little like this:

This parenting moment brought to you by Steve Jobs. Also, Ryan is still wearing that dress five days later. Pick your battles, people.

The only downside to my holiday celebration was the black cloud of over my head that we all like to call Benefits Open Enrollment.

:::

Scott’s company was bought out last year, and then someone bought the company that bought them. I think. They added a name to their name, but everything has otherwise been more or less business as usual.

But then word came down that, Great News! We’re going to go on another company’s benefits program! Yay! Scott seemed pretty sure that, since the new company was so much larger, this would mean having an easier time with benefits.

I, on the other hand, know better, and was not particularly thrilled about this—you know, the devil you know and all of that. But also, even though our insurance company’s payment record on claims they should cover is marginal at best, I at least have a third party familiar with my case that goes to bat for me. In addition, as the policy was written in New York, I was about to get a lot more help in the form of New York’s Raging Awesome Autism Mandate.

And it turns out that I was right to be concerned. The new plan is self-funded, which disqualifies it from all Raging Awesome Autsim Mandates. In addition, I couldn’t find any language in the plan about autism.

I called the benefits people to check on what was covered, and when I got the answer, I started to cry.

:::

Luckily, the head of HR for Scott’s company reads the blog (New Jersey shout out!), and, correctly identifying the possibility of literally months worth of teary, wine-feuled rants against insurance injustice with titles such as, “In which I write another strongly-worded letter of complaint,” called the head of benefits and suggested we all have a little chat.

“This plan is the same as your plan,” the benefits lady said.

But it wasn’t. Our current plan has, buried on page 1,754, a little gem of a nugget about neurobiological disorders, including autism:

Autism Spectrum Disorder Services will be paid the same as those stated under Primary Physician Office Visit within the Physician Office Services – Sickness and Injury benefit category.

This one sentence gives us speech and OT with no maximum benefit. Our insurance company didn’t even know that line was in there, apparently, because when we asked them about what it meant, they asked us—and I like to imagine all of the blood draining from the rep’s face as she asks in an urgent whisper—“Where did you get that?”

We got it from them, of course. And they were none too happy about it, either.

:::

I met a little kid one time who told me her dad lived in Florida.

“Wow,” I said. “Do you get to go to Disney World when you visit him?”

The girl ran off to find her mother to ask if this was a possibility, and I was later asked by the mother to drop the whole Disney thing because “Florida” was a euphemism for “prison.”

I tell you this story not because it’s relevant, but because it’s probably a lot more interesting than my insurance company woes.

But here’s the thing about insurance: You don’t care about it until you care about it. And then you care a whole hell of a lot.

The head of benefits tried to explain to me that the new plan was the same as the old plan. “You get 20 visits of speech, just like you do now.”

I drew a deep breath. “ACTUALLY WE GET UNLIMITED BENEFITS AND THE NEW YORK ATTORNEY GENERAL WAS INVOLVED AND ALSO THE NEW PLAN DOESN’T MAKE A PROVISION FOR SPEECH THERAPY UNLESS YOU HAVE AN IMPEDIMENT WHICH WOULD EXCLUDE AUTISM AND FOR SOME REASON THE INSURANCE COMPAY THINKS THAT $35 IS A REASONABLE AMOUNT TO PAY FOR A SPEECH SESSION WHEN YOU CAN’T EVEN GET YOUR CAR WASHED FOR THAT UP THE STREET AT FAST EDDIE’S BY THE TIME YOU TIP THEM,” I said.

There was a long and thoughtful pause on the other end of the phone, and they said they’d call me back.

:::

And so they fixed it for me. Speech and OT, no maximum benefit. Just like that. And the benefit lady had it “hardcoded” in to the system. I have no idea what that means, but it sounds good, yes?

I think so, too.

It doesn’t solve the problem of an insurance company that thinks $35 is a reasonable amount to pay against a $180 claim, but one fight at a time, and this one was a big one.

Plus, between Mr. X and my ongoing battle with our IEP team, I was just glad to have something go my way. If it hadn’t, I might have had some kind of horrible breakdown, landing myself in the hospital for “exhaustion.” Or worse.

I could’ve ended up in Florida.

In which the boy writes a letter to Santa

Kai: Need an envelope.

Me: For what?

Kai: Raisins.

Me: Why are you putting raisins in an envelope?

Kai: For Santa.

Me: That's sweet. I'm sure he could use some raisins. Should we write him a letter, too?

Kai: Yes.

Me: Great! A letter! Let's get a sheet of paper and—

Kai: Raisin starts with R. We will write an R. (writes an R on the envelope) All done!

Me: Uh—

Kai: Santa loves R's!

Me: (ruffles the boy's hair) Santa sure does, kid.

He sure does.

Here I am, on the road again

Hey, you guys! What’s up? Have you missed me? No? Well, that’s okay. It’s not like I’m saving the world or anything. In fact, I haven’t been doing much of anything lately.

I’ve just been in the car.

I’ve been trying to figure out why my e-mail inbox has over a thousand unopened e-mails. And why I haven’t had any time to write. Or gotten my ducks in a row for my next fight with the insurance company. Or called my parents or changed the water in the fish bowl or made an appointment at the car dealer for an oil change or taken in my dry cleaning or ordered new pillow cases to replace the ripped ones (?!) or any of the marketing stuff I told my friends I’d do for them and that they actually pay me good money to do.

Turns out, it’s because I’ve been in my car.

We go out to the suburbs for occupational and speech therapies, and to meet with Sue the social worker, therapists that we love, who have been with us forever. I used to pull Kai out of school for these appointments, traveling across expressways at times that were convenient for me. On a good day, you could make it out to Villa Park in 25 minutes.

But now that Kai’s in kindergarten, and he’s learning things like “reading” and “math,” I’m less inclined to face the wrath of his teacher pull him out of school. Which now lasts longer thanks to Rahm Emanuel, whose kids don’t even go to public school and who—oh, forget it. Don’t get me started.

It takes a solid hour and five minutes to get to therapy. Thanks, Rahm.

Jerk.

Anyway.

Kai, Ryan and I drive for over an hour, through city streets because the expressway is so congested, through neighborhood after neighborhood, suburb after suburb. We spend two hours at therapy and head home in the dark, hungry and tired, long after dinner time, after bath time, the Eisenhower a sea of red brake lights. Around the 9^th Avenue exit I start to struggle to keep my eyes open. I roll the window down or sing, sip my fifth Diet Coke of the day.

But that’s not really the crazy part.

The crazy part is that we do it not once a week, but twice.

:::

I took Kai to a neurologist last week. I’ll tell you all about it one of these days. That guy’s in the suburbs, too, but in the opposite direction.

On the day of that appointment, I looked in my dayplanner and discovered that Ryan had a doctor’s appointment that day, too. (She was only turning three years old--it's no wonder I completely forgot it, right? Right? Blergh.)

Anyway, so I scrambled to get her up to Skokie to our new pediatrician. It takes about forty minutes to get there and I wondered, not for the first time, if it was worth it to haul the kids up all that distance. Even if there is a drive-thru Starbucks on the way.

After her appointment, I schlepped back to the city and picked Kai up for his appointment, plugging the neurologist’s address into my phone’s GPS and following the directions back up to Skokie.

Up the expressway and past the drive-thru Starbucks, along the same route I’d just taken with Ryan not two hours ago, past her doctor’s building and, damned if this guy wasn’t in the building right next door.

:::

The neurologist looked over the list of things we do for Kai—his OT and speech, his visits with Sue, not to mention what he gets at school, not to mention school itself.

“There’s one thing I’d like to see that’s missing,” he said.

I raised my eyebrows slightly, intrigued. This was going to be the magic bullet.

“He should really be doing some kind of activity, like basketball or something,” the doctor said. “You know, so that he can feel like he’s part of a community.”

I actually laughed out loud.

“I totally agree,” I said. “When can you pick him up?”

Kai and Mommy in our natural habitat--a Lexus.

 

 

Here comes a storm in the form of a girl, she's the finest, sweetest thing in the world*

You forget, or at least I did, from one kid to the next, just how bad things can be. Or maybe it was the drugs. When Kai turned three, I still had some left over from Ryan’s birth, so it’s kind of all a blur. But I do remember that the terrible twos are a complete misnomer, as they start at around 18 months and end around the time your kid turns four, with a peak juuuuuuuuuuuuust about now.

Just the other day, Ryan threw about 7 tantri before 9 am for various reasons—she wanted to wear her princess dress, she wanted the iPad, she wanted her rainbow boots and not her pink mary janes, she wanted to watch Dora, she wanted milk not juice, and her toast was, and I quote here: too big.

Her toast was too big, you guys. It. Was. Too. Big.

She doesn’t want to ride in the cart. Or hold my hand walking through a parking lot. Or my help getting into or out of the car. “I can try,” she says.

In the cart under protest. 

She wants to choose her own clothes, which currently involve a series of Halloween costumes and her rainbow rubber galoshes, which she often wears on the wrong feet.

“Let me help you with that,” I say.

“No! My boots, my boots,” she howls.

I’ve been trying to capitalize in her desire for independence, and bought her some Dora underpants.

“You’re such a big girl,” I say. “Don’t you want to start using the potty?”

“No potty,” she says, and tosses the underpants over the side of the changing table.

But for all her big-girl-no-hands bravado, more nights than not she wakes up and cries and I gather her up, stumbling back to my room in the dark and we snuggle under the covers together. She flattens out her skinny, jackrabbity body against me and falls instantly back to sleep, curled into me like a favorite stuffed animal from when you were a kid. She’s never too hot or too heavy, she doesn’t sleep sideways or snore.

:::

Yesterday, she refused to let me unbuckle her car seat, insisting that Kai do it instead. She refused to wear anything but her ballerina costume. Over her pajamas. To school. And after all of that, despite the chill in the air, she refused to put on her socks. Or her shoes. 

Or a coat.

I made her an entire dinner that she decided she didn’t want, and when she told me what she really wanted, I made it, thinking the whole time about where my own mother would have told me to go under the same circumstances. And after all of that, she didn’t eat that dinner, either, because it was, and I quote again: too yucky.

She cried because one of her blueberries had a stem attached. And because she got marinara on the tutu she refuses to take off. She cried because I forgot to put a straw in her milk, and because the iPhone ran out of batteries, and because her doll’s shirt was crooked, and because I put on the wrong episode of Team Umizoomi.

But it was the darndest thing. When I went to bed that night, I reached for the chain to turn off the lamp and realized I couldn’t wait for Ryan to wake up in a few hours, so we could curl up against one another and sleep.

Because the moment in the small hours of the night, that she lays her head on my shoulder, and I feel her melt against me, might be my favorite thing in the whole world.

:::

The other day at the grocery store, she heard a song on the PA system that she liked.

"Mommy, it's dancing time," she said, taking my hand and twirling in a circle.

And so we danced in the middle of Whole Foods.

Because she is just that awesome, and all of this is so, so fleeting.

 

*From Heaven Tonight by Hole

In which we meet a part-time pirate, a full-time princess, and the boy hands out candy and lessons

This has been the first year that Kai really understood the mechanics of Halloween.

Last year, despite the endless costume changes, he really had no clue that he was supposed to wear a costume to ring doorbells for candy. And in fact, after the annual block party, rather than trick-or-treating, he took off his costume and watched Diego.

This year, he’s had his costume picked out for a month and a half.

The house looks like I bought every single piece of construction paper, pumpkin decorating kit, googly eye and pipe cleaner at Michael’s.

Every day he asks me if it’s Halloween yet.

Finally, I got to say, “Yes.”

:::

In OT the other day, Emily asked him what he was going to be for Halloween. He gave the answer he’s been giving forever.

“A pirate!”

She asked him what he was going to do on Halloween.

“Trick or treating!”

What do you do when you ring the doorbell?

“Say ‘trick or treat!’”

Then what?

“Get candy.”

And then what do you do?”

“Say ‘thank you.’”

You guys, he was ready. It was time.

:::

After school, Kai raced to put on his pirate costume.

“I want pirate, too,” Ryan said.

Ryan had informed me and anyone else who asked that she wanted to be a pumpkin for Halloween. I didn’t really take her seriously given her propensity for princess/ballerina gear.

But as the day approached and her story never wavered, I finally got a little nervous that she was expecting a pumpkin, you know, situation.

So I went to Target and cobbled together this concoction, which was met with tears:

This is the last time I ever make a costume myself, you guys. Actual tears.

We did find a sort of compromise eventually:

But it only lasted about four minutes before Ryan decided that she just wanted to wear regular clothes:

This is what she wears every day. She has no idea what Halloween even is.

:::

Kai’s teacher called later on that night.

We had talked at report card pick-up the day before about Kai’s propensity to ask for help when he doesn’t need it. 

At journal time, for example, he asks the teacher or his paraprofessional to draw pictures for him.

“Can you draw an elephant?” he’ll ask. He does this to me, too. I’ll be in the middle of making dinner, and he’ll need my help to draw or paint or construct an elaborate battleship out of buttons and paper plates.

The thing is, that Kai can draw. And sometimes I don’t want to make an elaborate battleship.

“You can draw an elephant,” I’ll say.

“You can draw an elephant,” he’ll reply.

We'll go back and forth like that for a long time.

Sometimes he doubles down. “You’re a great artist.”

And in the end, I draw the elephant.

My theory about why Kai asks for help drawing pictures is that the fine motor stuff is hard for him. Scott’s theory is that Kai is frustrated that he can’t make a drawing look like the picture in his head.

I'm going to find him some drawing lessons. In the meantime, his teacher and I are going to try to get him to draw his own pictures. He needs to work on his fine motor and he needs to solve some of these problems himself. She started that day.

Kai was asked to do a journal entry about his Halloween costume.

“Ms. Monica, can you draw a pirate?”

Kai’s teacher said that she was too busy. “You can draw a pirate,” she said. "And when you're done, you can have a sticker."

He asked his paraprofessional to draw a pirate.

“Kai, try to draw a pirate yourself,” she said. 

Kai sat down at the table and picked up the crayon.

“Oh! I forgot,” he said. “I’m going to be a circle for Halloween.”

And with a single stroke of a crayon, Kai outsmarted us all.

:::

After Kai was done trick-or-treating, he helped me hand out candy to the other kids.

He greeted everyone and commented on their costumes and, when necessary, schooled them on the mechanics of the whole Halloween operation.

“Now you are supposed to say, ‘thank you.’” He said to one kid.

It was a nice reminder. Not just to the younger kid, but to all of us, that Kai almost always gets a lot more than we give him credit for.