Mommy's Sweethearts

God's Faithfulness to us in the Middle of a Storm

2011-01-08T20:00:00.000-08:00

2011 started out to be rather scary for us. At 1:00 am on January 1, Josh called us to tell us that he couldn't sleep because Daniel was "talking." I thought he was having a bad dream, but when he wasn't responding, I turned on the light in their room to find him having a seizure. I tried to arouse him out of it, but nothing worked. I immediately told Frank to call 911. Within minutes, there were paramedics and a fire truck in front of my house. They came in, scooped Daniel up out of his bed, and immediately took him out to the ambulance. Somehow, in the middle of the chaos, I managed to call our pastor and post a quick prayer request on Facebook. It's all a blur now, but I know how important it is to take our requests to God. He's held Daniel's life in His hands since the day He created Him, and we know that He will be faithful to care for our son in everything.

We figured out that Daniel's seizure lasted at least 45 minutes; it's more likely that it lasted more than an hour - that's a very long time for a seizure. He also had a temperature of 103.4, and the doctors think that's what caused the seizure. Thankfully, the ER staff at Community Hospital got things under control very quickly. And the best part was that I recognized one of the nurses. Her daughter goes to school with my kids. The moment I recognized her, I knew that God was not only taking care of Daniel, but He was taking care of me. My childhood best friend has epilepsy, so seizures are nothing new to me. Seizures that won't stop, however, are very new to me, and I've never been so scared in my life.

From the day Daniel was born, I sensed that there was something "different" about him, but I couldn't put my finger on exactly what it was. He was a little behind in hitting most of his developmental milestones, but it was nothing to worry about. He had physical therapy to help him learn to walk, and he was walking after only one therapy session. At 2 1/2, he wasn't really talking in more than one-syllable words, so we called First Steps (Indiana's early intervention program) to have him evaluated. At that point, we saw an orthopedic doctor and a pediatric neurologist, and they said there was nothing to be concerned about with him. However, they were wrong.

We saw a neurologist at Children's Memorial who diagnosed Daniel with speech and verbal apraxia and recommended OT, PT, and speech therapy. In November 2008, we began seeing a developmental pediatrician, and her diagnosis was ADHD and autism spectrum disorder. The ASD diagnosis was not surprising because I suspected that he fell into that category all along. The ADHD was a little surprising, but I also knew that we could manage that with meds.

However, NO ONE addressed the sleep issues we were having, and NO ONE ever suggested doing a CT scan, an EEG or an MRI - until Daniel had a seizure and was transferred to Comer Children's Hospital at the University of Chicago. The first question Dr. Tonsgard asked was, "How long have these sleep disturbances been going on?" I told him that I couldn't remember a time when he didn't have them. I was hoping and praying that someone would order an EEG and a MRI to see what's going on, and that's exactly what he did. Finally, we might get some answers!

Sure enough, the EEG showed that he has Rolandic Epilepsy. It's a mild form, and it should go away between 16 and 18 years old. The MRI, on the other hand, showed something more. Daniel's cerebellum is smaller than normal, and the space in the back of his brain where the cerebrospinal fluid is, is a little bigger than normal. Neither of these things is anything we need to worry about, but they DO need to be monitored.

The end result is that I am thankful and blessed that God takes such care of Daniel. While going through such an ordeal is scary, getting answers is a relief. Now, we can pray more specifically for him, and we know that we need to be more vigilant at night (by putting a video monitor in his room). I've never doubted that God holds Daniel's life in His hands, and I know that He has a purpose in all that He does. I'm glad that He has a plan for Daniel, and I'm looking forward to seeing what He will do next.

So, I am choosing to trust Him and rely on His promises to care for Daniel. I am not going to worry constantly because that would just be a waste of time. I'm thankful that God loves us and that He is ALWAYS faithful to keep His promises.

Graduating From Speech Therapy

2010-07-14T20:50:00.001-07:00

It's still somewhat hard for me to believe, but Daniel will be graduating from speech therapy on July 27th. He will continue OT and PT for quite a while yet, but this is a major step in our journey. When his speech therapist first told me she was almost ready to discharge him, I had a hard time with the thought of him not being in speech therapy. After all, he's had speech therapy for over 4 years; it's become a way of life for us.

As I thought and prayed about the transition, it started to make sense. Not only that, but it will allow him to be in school for another hour before I have to pick him up for OT and PT. I'm hoping to get those therapies changed to different times, but for now, we'll stick with the current schedule - Tuesday afternoons from 2 to 4 pm.

I am once amazed by God's goodness and His faithfulness in Daniel's life. When we first started therapy and visiting pediatric specialists, the things I was told were not good. I envisioned Daniel in therapy for the rest of his life, and I also saw him never attending a "regular" school. Additionally, I figured that we'd have to support him, and that Josh and Annie would have to "look out for" him throughout his adult life. I've come to realize that I was completely wrong, and many of the medical professionals who painted the worst picture possible were also very wrong.

God is bigger than any diagnosis or disability. He holds Daniel's life in His hands, and He has a purpose and a plan that is greater than we could ever imagine. And I get the amazing privilege of watching Him work in Daniel's life. That truly is the best part - seeing His handiwork in my son's life every day. This journey is not easy, but I am blessed to be a part of God's plan, and I wouldn't trade it for anything.

The date of his last therapy session is very significant to me. My mom was my best friend, and that's her birthday. I wish she were here to see how far he's come in such a short time. He still remembers her, and he talks about her often. How wonderful it would be if she could hear those sweet words that we waited so long to hear!

God's Hand on Annie's Life

2010-06-15T20:20:00.000-07:00

During Annie's swim class tonight, I stayed in the locker room to work on my Bible study homework because it's terribly hot in the pool balcony. After I finished the study, I popped in to watch the end of her class because I was curious to see how she was doing. I watched her swim to the far end of the pool, and the teacher had all the kids turn to come back to the end of the pool where I was. I watched her swim almost all the way back, got distracted, and lost sight of her. When I didn't see her in the water, I noticed that she had already made it to the end of the pool. She was sitting on the deck, but something was not right. She was crying, and the lifeguard was walking over to her.

I immediately made a beeline to get to my precious girl to see what was going on. She was having trouble breathing. I wasn't surprised because her asthma and allergies have been acting up lately. I didn't even give the lifeguard a chance to help her. I helped her up and headed to the locker room, where I helped her calm down and quickly got her dressed. We were met in the locker room by another mom who also works at the Y. She was checking on Annie. I explained that Annie has asthma and that we were going home to do a breathing treatment.

Once again, God's timing was absolutely perfect! Who knows what would have happened if I wouldn't have gone into the pool area to watch her swim?!?!? Thankfully, I was there - exactly when she needed me - and I was able to help her.

Psalm 121

I lift up my eyes to the hills - where does my help come from?
My help comes from the Lord, the Maker of heaven and earth.

He will not let your foot slip - he who watches over you will not slumber;
indeed, he who watches over Israel will neither slumber nor sleep.

The Lord watches over you - the Lord is your shade at your right hand;
the sun will not harm you by day nor the moon by night.

The Lord will keep you from all harm - he will watch over your life;
the Lord will watch over your coming and going both now and forevermore.

Thank you, God, for watching over Annie's life and keeping her from harm!

Farewell, Aetna!

2010-06-15T19:15:00.000-07:00

When he came home from work yesterday, Frank asked me, "Did you get my last text?" I said, "No, I didn't. What did it say?" He then told me that, as of July 1st, we won't have to deal with Aetna anymore. His company decided to switch to Blue Cross/Blue Shield. I've been praying for this change for over a year! While it took longer than I would have liked, I have to remember that God's timing is ALWAYS perfect, and He knows what's best for our family.

I was even praying about it again yesterday, while I was driving home from the dentist's office. Little did I know that Frank would be cutting a check to Blue Cross/Blue Shield shortly after I prayed!

I am constantly amazed by God's goodness and His faithfulness. He knows our needs, even before they arise, and He is faithful to provide for them. He knew that Daniel needed a mom and dad who would fight for him, who would be diligent in getting him the care he needs, and He put Daniel in our family. I am blessed to be the mom of such a sweet, wonderful boy. I can't wait to see how God is going to use Daniel in other people's lives.

When God Speaks, I Shut Up

2010-05-05T07:34:00.000-07:00

Yesterday was an incredibly difficult day with Daniel. When Frank brought him home after Doughnuts for Dads, he was exceptionally quiet. He wasn't talking much, and he seemed disappointed to be with me. I'm guessing that's because he enjoyed his morning with Dad, and he didn't want him to go to work.

After therapy, the kids came home to fight with each other the whole time I cooked dinner, and Daniel was the worst offender. When dinner time came, he absolutely refused to eat. I spent the next 1/2 hour telling him that if he didn't eat, he wasn't going to his swim lesson. When Frank got home, he still wouldn't eat, and we ended up taking that privilege away. Then, the meltdown started. For the next several minutes, he cried and had a fit. He eventually ate his dinner, but I had to feed him.

Frank and Josh took Annie to her swim lesson, and I stayed home with Daniel. While Daniel was in the bathtub, I had a "fight" with God. Well, we all know who wins those! Through lots of tears, I told God, "How can you watch him struggle and not help him?" His answer to me was this: "I gave him YOU to help him!" While it wasn't anything audible, I clearly heard God speak those words to me. How can you argue with the One who holds everything in his hands?

I am Blessed

2010-05-02T22:45:00.000-07:00

In the past few days, I have really felt blessed by my children. They haven't done anything special to bless me, but I feel blessed to have such amazing kids. I took them for new sandals for the summer, and the woman who helped us in the shoe store had nothing but good things to say about them. She even called Annie perfect! Of course, I don't tell my kids that they are perfect, but I do encourage them when they try their best.

I've been noticing that their willingness to obey and to do their best in whatever they do is increasing, and I am having to discipline them less. Part of our discipline process has always been looking at what the Bible says about how we are to act and how we need to treat one another. I can see the results of what we've been teaching them, and I consider it a privilege to teach them these important truths.

It's Been a While!

2010-04-18T20:07:00.001-07:00

Well, Aetna is still denying our claims regularly. The latest claims they're denying are our trips to the ENT for my sinus troubles and Annie's nosebleeds. I received an EOB last week, denying the claim, and stating that they did not receive the information they requested from the Dr.'s office, so we were responsible for the entire cost of my visit - all $890 of it! At that point, I called the billing department and spoke with someone who told me that they sent Aetna the information on March 1. She also said that she spoke with someone named Tanya at Aetna, who confirmed that they did, in fact, receive the medical records they requested. She also told me that this happens all the time with Aetna. My response - I'm not surprised!

I can hardly wait to see what they do with the claim from Annie's visit. They pended the claim, stating that they requested medical records. I wonder how soon it will be before I get an EOB stating that they didn't receive them and that the entire bill is our responsibility.

Needless to say, I contacted the guy who helped us get the therapy stuff straightened out, and I should be hearing back from him very soon.

More Aetna Antics

2010-03-12T11:36:00.000-08:00

Well, I haven't posted about Aetna in a long time, but they are still up to their old tricks. Since we showed them that they have to cover Daniel's therapy by law, virtually every claim for me that is not for a doctor visit has either been pended or denied. Interesting. Apparently, filing a complaint with the Illinois Department of Insurance wasn't enough to keep them in check. Their latest thing is a denial of my ER visit on Labor Day weekend for a throat infection. Apparently, I wasn't sick enough need medical attention. Before I went to the ER, I searched their website for the nearest urgent care facility, and I found one located right here in Hammond. The problem - I was sick on a Saturday morning, and the urgent care facility is only open Monday through Friday. My doctor does not have Saturday office hours, and he was not available by telephone. I had big white spots in my throat and a fever of 101.7. Apparently, I was supposed to just stay at home and get sicker. The antibiotics that cleared up the infection were a covered expense, but seeing a doctor to get a prescription for them was not. Yet, I never would have gotten a prescription for antibiotics without first seeing a doctor. Way to go, Aetna!

It's That Time of Year Again

2010-01-23T21:35:00.001-08:00

Well, tax season is here, and I will be going back to work for a few months very soon. While I'm not looking forward to working 8 hours every Saturday, I am looking forward to getting a paycheck. I can't believe it's my 5th tax season!

Each year, I usually treat myself to something fun with some of the money I earn. I can't decide what that will be this year. Hmmm...there are soooo many things to choose from!

God is Faithful!

2009-09-21T08:23:00.000-07:00

I got a letter from Aetna this morning, indicating that they were reversing their decision not to cover Daniel's therapy - but only for the month of July! Our initial letter of appeal requested that they reverse their decision not to cover therapy at all for all claims going forward. They must think we're not serious about making sure they follow Illinois law in providing coverage for his therapy.

As I sit here on hold, waiting for their senior representative to see if she can get a definitive answer about coverage for claims going forward from July on, I am planning to forward more information to the Illinois Insurance Commission. In our conference call with Aetna's representatives, we were told that their medical directors were board-certified family physicians. My letter says that a "medical director, board certified in Obstetrics and Gynecology," was involved in the review of our appeal. I find that quite interesting. When did an OB/GYN become a FAMILY doctor?!?!? What are their credentials in PEDIATRIC medicine? I'm sure that Daniel's doctors would be interested to know this. This is why I never believe anything anyone at Aetna tells me, and it is why I take very detailed notes every time I call them.

The findings of this, my latest call - therapy will be covered without limits under the directives of the Illinois Autism Mandate. I have documented the name of the person with whom I spoke, as well as everything she told me regarding how our claims will be handled. We'll see where we go from here. Hopefully, this is the end of the battle. Aetna stole an entire summer away from me and my children, and I will not allow them to steal any more of our precious time. If they do not cover therapy in accordance with the IL Autism mandate, I will seek legal counsel. Enough is enough. This never should have gotten so out of hand in the first place. This law was signed in November 2008, and it was effective for us when our policy renewed on July 1, 2009.

I find it interesting that, when I spoke to Aetna's representatives in June and told them he has an autism spectrum disorder, they told me they do not cover treatment for autism spectrum disorders. Yet, I'm sure they knew about the new law, and they were trying their best to get out of providing coverage, thinking we'd never find out about it. It was signed in November 2008, and it was effective December 18, 2008.

God holds Daniel's life in his hands, and He's not about to let an insurance company get away with such unethical practices. He has a purpose and a plan for Daniel's life, and He will make sure that no one, not even an insurance company, gets in His way.

"And we know that in all things God works for the good of those who love him, who have been called according to His purpose." Romans 8:28

My Little Angel Sent From Heaven Above

2009-09-07T19:23:00.000-07:00

For the past couple of weeks, Annie's been calling me her angel sent from heaven above, mainly due to the fact that I killed huge centipede in the boys' room, and she's terrified of bugs. Tonight, as I was tucking Josh back in bed after he got up, I told him he was my angel sent from heaven above, and I was struck by the truth in those words. He was our surprise baby, born just 3 1/2 months before my mom died, and I have no idea how I would have gotten through the months following her death if I wouldn't have had a small baby to care for.

Annie was in preschool 3 afternoons a week, and Daniel was in preschool 4 mornings a week. While I had one older child home at all times, Daniel still took naps in the afternoon. Having Josh to take care of was such a blessing! I can remember so many times when I would think of my mom and look at Josh and see nothing but hope in his little life.

I still am filled with hope when I think about Josh. Having a child with sensory processing disorder can be very difficult and discouraging. Watching Daniel struggle through much of his life has been hard, to say the least. Watching Josh outdo himself over and over again is very encouraging, on the other hand. While I have to keep on my toes to stay one step ahead of him, it is absolutely amazing to watch how he interacts with people, and it is wonderful to see him grow and mature. He truly is my little angel sent from heaven above!

Unbelievable!

2009-09-03T12:35:00.001-07:00

Well, Aetna is up to their usual tricks again. What else is new?!?!? This time, it's absolutely ridiculous. We filed our appeal on August 17th and faxed additional info on August 27th. We faxed and overnighted all of these documents when we requested our predetermination for coverage back in July. All of a sudden, the paperwork we sent them on August 27th is "new" information. Interesting, to say the least.

They told us that once a formal appeal was opened, they would allow Daniel's doctors and therapists to do peer to peer reviews. Wrong-o!!! So far, Daniel's doctors and therapists have called for peer to peer reviews, and they have been rejected. His therapists tried calling the same week we filed the appeal, and they were told one hadn't been filed. The flaw in that is that Frank FAXED everything for the appeal, and they most certainly did have one opened on August 17th. Yesterday, they refused to let our pediatrician do one, and they even hung up on her. Nice! I confirmed with our neurologist's nurse that he tried to call late last week, and he was turned away - for a 2nd time!

Apparently, they don't get it. I will not be bullied, and I will not give up on making sure Daniel's therapy is covered as mandated by Illinois law. This is getting rather old.

They did talk to Daniel's developmental pediatrician, but it was only AFTER we faxed them a second copy of documentation stating he meets the criteria for autism spectrum disorder. They never intended on speaking to any of Daniel's doctors about his healthcare needs. Now, they're suddenly interested because they are bound to cover therapy by law. I'm sooooo tired of all these antics.

There IS a Light at the End of the Tunnel

2009-08-28T20:45:00.000-07:00

I spoke with the nurse at Daniel's developmental pediatrician's office today, and she confirmed to me that Daniel does, indeed, have an autism spectrum disorder. She faxed the information to Frank at work this afternoon; he will be forwarding that information, as well as a copy of the Illinois autism mandate, to Aetna on Monday morning.

I called Aetna's customer service number this week to find out which diagnosis codes were used in the billing for our visits with the Dev. Ped., and their representative told me what they were. She also confirmed to me that they were appropriate codes for this autism spectrum disorder diagnosis. Daniel started seeing this doctor on Oct. 30, 2008 - his 5th birthday. It was after the new legislation went into effect for us (August 2009) that Aetna denied our request for coverage for therapy. The reason we were given - we do not have coverage for this type of services. Really?!?!? According to Illinois law, we most certainly do. I'm interested to see what the outcome of our appeal will be. We do have an attorney, and he will call Aetna if necessary.

The funny thing is that I've had numerous therapists and doctors tell me not to give up because that's what Aetna wants me to do. They call it the insurance game, and that's what I was calling it before any of them ever mentioned that phrase to me. Only 2 people have tried to talk me out of continuing therapy, but I just knew that God was going to work this whole thing out somehow.
I truly believe that God directs every step we take in our lives, and it was by no accident that we decided to take Daniel to a developmental pediatrician and that we found out about the autism mandate. I posted a couple of Facebook notes about this, and I tagged a friend in the note who is an attorney who is familiar with this type of thing. She was not in my mind immediately as I was tagging people, but something kept telling me I should tag her in the note. I listened to that still, small voice, and it proved invaluable. She posted a comment on locating advocacy groups for help, and I did just that. I googled advocacy groups in NW Indiana, and I called 5 of them.

Two people called me back - one who really didn't help me and another one who had more information than I could have ever hoped to find. She's the one who pointed me in the direction of Illinois' law regarding insurance coverage for children with autism spectrum disorders. She also told me about the new legislation Gov. Quinn signed regarding coverage for children with developmental disabilities. That law takes effect on January 1, 2010, and I'm telling everyone I know about it. The more we moms of kids with special needs can help each other, the better.

It's very comforting to know that an insurance company like Aetna would seek to deny a child the only treatment for his medical condition(s) that would help him overcome it, but God will not allow such a thing to happen. One of the songs we sing at home and in church talks about how He's the Defender of the weak, and I can definitely see that in Daniel's life. Because of his sensory problems, virtually everything for him is a struggle - eating, brushing his teeth, writing his name, etc. Yet, God has brought him this far, and He's not about to let an insurance company stop what He has started in Daniel's life.

God definitely has a purpose and a plan for Daniel's life. He is amazingly sweet and kind-hearted. I truly believe that he's come such a long way in the past 3 years because we have not only made sure he has the medical care he needs, but we believe that God has much more planned for him than we can ever imagine.

"For I know the plans I have for you," declares the Lord, "plans to prosper you and not to harm you, plans to give you a hope and a future." Jeremiah 29:11

God is Good!

2009-08-25T12:56:00.000-07:00

I spoke with an Indiana Special Kids advocate this morning about the problems we're having with Aetna. As it turns out, the governor of Illinois recently signed a bill that requires insurance companies to provide coverage for children with developmental disabilities. That bill goes into effect on 1/1/10. All we have to do is find a way to get coverage for the 6 months prior to that, and coverage for Daniel's therapy will be covered as mandated by law. I'm sooooo glad our insurance is through a company in Illinois!

She also pointed me in the direction of an IL Senate bill that mandates coverage for autism spectrum disorders. Daniel's developmental pediatrician says that he IS on the autism spectrum. I requested copies of that documentation from her, and we will be faxing that info, as well as a copy of the IL legislation, to them ASAP. I would think that they would want to comply with Illinois law. Apparently, I am wrong. This only solidifies my complaint with the IL Insurance Commission. I will be faxing copies of all this paperwork to them as well.

Time for School

2009-08-24T21:25:00.000-07:00

Well, it's time for school to start again. Annie will start second grade, and Daniel will go to kindergarten - a "normal" kindergarten. I am confident that my sweet little girl will shine like a star, as she usually does. She is truly a gift from God. I'm really going to miss hearing her laugh and seeing her smile throughout the day every day while she's in school. I am looking forward to seeing her run across the playground and crash into me with a giant bear hug every day. That's the best part of the school day. It is such a blessing and a privilege to be her mom. She brings so much joy and happiness to our home.

I can't decide if I'm looking forward to seeing Daniel go to kindergarten or if I'm sad because I'm going to miss playing games, practicing writing, playing outside, and cuddling on the couch to watch movies with my sweetheart. I can not believe how much God has done in his life in such a short amount of time. 3 years ago, he was barely talking, falling all the time, unable to feed himself, unable to play and keep up with Annie and other kids his age. Now, thanks to God's never-failing hand in his life, he can speak in sentences, feed himself, play and keep up with other kids, and write his name. His teacher is a Christian woman who loves her students like they're her own kids, and I'm excited to see how God will use her in his life.

It looks like Josh will go to preschool too. I am currently in the process of becoming a substitute teacher, and we're looking into child care for him. There's a Christian daycare center that I'll be visiting later this week that has curriculum, even for Josh. I think the structure of daycare will help with his behavior, and God will use his teachers to lovingly help change some of his naughty behavior. I'm looking forward to seeing him grow and mature over the school year, and I'm looking forward to spending Tuesdays alone with him.

My Other Poor Baby!

2009-08-24T15:16:00.000-07:00

Yesterday afternoon, the kids were playing while I was cooking dinner and Frank was mowing the lawn. Annie came to me crying about Josh bumping into her chin with her head. I took a quick look, and everything seemed fine. Almost 3 hours later, she finally decided to tell me, "Mommy, when Josh hit my teeth, the pieces came out." My heart sank. I hadn't noticed anything wrong with her teeth, but I decided to take a second look. Sure enough, one of her bottom permanent teeth was chipped.

We went to the dentist and had it bonded today, but it will eventually need a crown. There's never a dull moment around here!

My Poor Baby!

2009-08-21T21:28:00.000-07:00

Yesterday afternoon, Daniel came in the kitchen holding his right leg with both hands and crying, "my leg hurts." I didn't think too much of it since I had him sit down, and it stopped hurting. He got through the rest of the day without any complaints, and I thought everything was fine. At 1 am, he was up, crying, holding his leg, and hardly able to walk. He finally told us that he tripped on a toy and fell, and that's how he hurt his leg. Frank took him to the ER, and they did some x-rays. However, the not-so-bright ER doctor couldn't tell if he injured the growth plates in his leg or not. Then, they made Daniel an appointment with a pediatric orthopedic specialist for 8:30 am. When Frank called to tell me, I told him that there was no way we were ever going to set foot in his office at 8:30 am. He is not Daniel's physician, and I certainly am not about to take him back to this doctor ever again.

When Daniel was 2 1/2 years old, he had fallen and cut his face badly enough to warrant glue and stitches 3 times in 8 months. I took Daniel to this doctor to be evaluated and to get an order for SMO's (the braces he wears on his feet). He informed me that there was nothing wrong with him and that he didn't need anything for his feet. He was rude, and he treated us like we were a bother to him.

Tomorrow, we go to Daniel's regular orthopedic specialist to determine what is going on with his leg. Perhaps treatment for this injury will include physical therapy. Aetna can't deny coverage for therapy to treat an injury. I think God allows things to happen for a reason. Perhaps this is His way of allowing Daniel to get some therapy that can't be denied by an insurance company.

Aetna Insurance

2009-08-20T10:58:00.000-07:00

It's been about a year since Daniel started therapy at St. Margaret Pediatric Rehab, and he has made tremendous progress. His therapists have done much more in only one year than the therapists in the public schools did in almost 2 full school years. A year ago, Aetna assured me that therapy would be covered for him, so we started him in therapy. Without our knowledge, someone at Aetna decided to stop covering his therapy in January. Additionally, we NEVER received a letter from them about that decision. When I called to find out what was going on with claims in June, they finally decided to tell me about that decision - over 5 months later! Because they gave me false information and failed to inform us of this decision, they decided to cover therapy through June 30.

We had a conference call with some of their reps, and we were told to mail and fax information to them regarding Daniel's medical condition, so that they could help us. Now, they are denying coverage stating that we don't have such coverage in our policy - something they should have told me a year ago. They admitted that they never took Daniel's medical information into consideration in their flat denial of our request. Needless to say, I filed a complaint with the Illinois Department of Insurance because Aetna has been misleading us for an entire year. Enough is enough!

Daniel sees a pediatrician and 3 pediatric specialists on a regular basis. All of his doctors and therapists agree that he is at risk for injury and regression if he does not receive treatment. He even has a documented history of injuries and emergency room visits for treatment prior to receiving therapy. You would think that Aetna would want to cover his therapy as a preventative measure. They're going to have to cover all claims if he gets hurt. To top that off, we were told that their "medical directors" are "family physicians." They don't have any pediatric expertise, and none of them are licensed pediatricians - nice! Seven pediatric professionals can't all be wrong!

Of course, we have also asked his doctors and therapists to do peer to peer reviews with them. When Daniel's speech therapist called yesterday, they refused to let her have a peer to peer review, and they told her that they don't have anything for her to do a peer to peer review on. Yet, we received an email confirming that a Level 1 appeal has been opened. Once again, they are contradicting themselves. I'm not surprised.

Last night, I combed through every bit of our insurance information, which it took over a year to get, and discovered that speech therapy is allowed for pervasive developmental disorders - something Daniel DOES have. That is mentioned in the notes from his first visit to his developmental pediatrician, which was faxed to Aetna. The information we have provides coverage for speech therapy for this disorder.

The fact that Aetna would deny a child with Daniel's disorder coverage, and ask me not think badly of them in our conference call, is puzzling to say the least! I'm quite sure that if this were one of their children, coverage would be provided, and they wouldn't have to go through this.

It's amazing how they contradict their own corporate mission statement in all of this - "We seek to achieve superior customer satisfaction through innovative products, comprehensive health and related benefits choices, effective service and easy-to-understand information. Our goals are: To give individuals and families affordable coverage choices, helpful service and information so they can make better-informed decisions to optimize their health and financial security. To respect and work effectively with doctors and hospitals by establishing efficient processes and providing prompt claims payments and useful information that helps them provide safe, cost-effective, high-quality health care." If they were truly dedicated to all that they say they are, they would take Daniel's medical needs into consideration and work with his family and his doctors to give him the high-quality health care he needs.