Thursday, March 13, 2014

Its Never Good When a Suggestion Starts With....

You're a stay-at-home mom, right?

You want to go there? Okay, lets go there.

This was said to me by a Psychiatrist in Baltimore. Baltimore is an hour away from my house. She restricts her office hours to 9am-3pm (school hours naturally) therefore for us to see her and get medication prescriptions my 12 year old needs I have to:

  • Drive an hour towards Washington DC to pick up my son from school. 
  • Drive 1.5 hours around the Washington DC beltway to the Baltimore beltway and into the heart of Baltimore.
  • Have a 20 minute appointment with this doctor. 
  • Drive an hour home (because obviously I am going to schedule this appointment early or late in the day).
This is an example for ONE specialist, we have 10. You want to know how I spend my time? I spend my time in the car going to these appointments, then I spend my time faxing, filing and submitting insurance claims for this appointment, then I spend my time on the phone with your scheduling line because you want to move our appointment AGAIN, then I spend time on the phone with our insurance company because you are "out of network" and why wasn't this appointment applied to the deductible and THEN I get to spend time on the phone with Medicaid, your billing people and our insurance company because between the three of you there should be $0 balance. 

So go ahead and tell me your solution that will all be solved because I am a stay-at-home mom.... go on... 

Our psychiatrist wants me to set goals for my 12 year old on socialization, playing nicely with peers and his brother and working within the community. These are ALL good things and I totally agree. To accomplish this she suggests that we use the Maryland Autism Waiver's hours for Intensive Individual Support Services (IISS) and Therapeutic Integration (TI-social skills classes, art therapy, music therapy) while utilizing the resource of Family Training to set goals. The good news is that we have the Maryland Autism Waiver, we sat on the wait list for 8 years and our name finally came up. The bad news is that the waiver is broken and these magical hours only work if you can find a PROVIDER for IISS, TI and Respite. 

Usually you sign up with a group that provides these services, they manage the paperwork and the documentation, keep track of your allowable hours and submit to the Waiver for you. Each month you HAVE to use either IISS, Respite or TI or you risk losing the waiver. So what happens when the group you sign up with have no IISS and Respite workers available and there is no TI available in your area? Then you fire the group that you have been using and you find another one... who has the exact same problem, NO IISS and Respite providers and there are still no TI opportunities in the area. 

So as I was explaining to this doctor, we have the waiver but I cannot find any providers and I am worried that we will lose the waiver. You see the waiver comes with Medicaid and Medicaid pays for the part of this appointment (and all other appointments) that our insurance doesn't and it pays for prescription co-pays. But using Medicaid doesn't "count" towards using the Waiver, only IISS, TI and Respite "counts" so we really need to keep the waiver! 

Her solution:

You're a stay-at-home mom, right? You can coordinate the waiver yourself and cut out the middle man. 

I'm not saying this is a bad idea, it's just an idea based on the false assumption that I HAVE THE TIME to manage the paperwork, coordination, hiring, resourcing, tasking and billing involved. I'm not even saying that it's completely out of the question because I may be out of options since the new group I've signed on with failed to place someone in my house for even an hour of services last month.  So, no, it's not a bad suggestion but PLEASE fortheloveofgod don't assume that I have the time because I'm a stay-at-home mom!!!!!

Given enough time, I could manage the waiver myself.
Given enough time and money, I wouldn't need the waiver.
If I had more time, I would go to the top and try and fix the waiver.
For the people who neither have the time or the money, like us.

(**There will be another post about the Maryland Autism Waiver soon, less rant-y, more informative. Until then, see links below.**)

Maryland Autism Waiver Fact Sheet
MD Department of Education (who implements the waiver)
Waiver Guide for Families


  1. Ugh. There's another post right there- the schism between your working outside the house female psychiatrist and the working outside the office mom.

  2. You would think someone that works with parents who don't have the "luxury" of the option of working would know better than to lob that out there without offense... (or she simply doesn't care.)