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My daughter’s health insurance company couldn’t care less

September 29, 2014

hearingOPINION By HILARY GRANT

Looking back, it all began when my smart, beautiful and spirited teenage daughter was in first grade.

Her teachers told me Katie could hear perfectly well, but darn it, she just didn’t listen. Treated as a behavior problem for years, I now know that, in fact, my child was physically unable to listen.

My daughter suffers from Central Auditory Processing Disorder, often known as CAPD. Recognized as a bona fide disability by the Americans with Disabilities Act, Katie hears fine, but her brain has a difficult time processing words and ideas.

There can be a genetic link to this learning difference, and it is also common in children who have suffered from multiple ear infections at a young age. Or, like Katie, it’s common for children who lived in orphanages for the few months or years of their lives, often starved, and then, like my child, were finally adopted. Katie was nine months old the day I took her home from China.

Although lots of folks have never heard of it, CAPD is a very big deal.

Why? For one thing, the specialized audiologist who diagnosed Katie believes up to 70 percent of those in prison suffer from some sort of learning difference that was never diagnosed and never treated. I’m a pretty cynical cookie, but this figure astounds me.

Still, it makes sense.

After all, kids with CAPD, and other learning differences, often do poorly in school, suffering from short-term memory, an inability to take notes and crippling test anxiety.

The good news is that CAPD can be successfully treated. With a trained specialist working one-on-one with a child, along with equipment that includes special CDs, headphones and other auditory props, permanent improvement can often be seen within a few months.

The bad news is that most health insurance companies—including MediCal, which my daughter has, or California Children’s Services, which is supposed to cover what MediCal won’t—refuse to pay for either diagnosis or treatment costs, which can quickly add up to several thousand dollars. This, despite the fact that CAPD is a physical impairment that affects learning and living, just like being deaf or blind affects learning and living.

No child wants to fail school. But as long as physical learning differences are left uncovered by health insurance, tens of thousands of children will continue to go undiagnosed and untreated. This is a recipe for disaster into adulthood.

I’m just one mom crying in the desert. So, I created an online petition to demand that children with these physical impairments be covered by health insurance companies. It’s a small start, but it is a start.

Scrape a few million dollars off the obscene bonuses made by health insurance CEOs, and I promise you, the money will be there.

Please, sign my petition at change.org.

Hilary Grant is a writer, cookie baker and mom who lives in Los Osos

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This letter went from being an enlightenment on CAPD to a more important discussion on Welfare and Health Insurance. The definition of Welfare on Invsetopedia is “A government program which provides financial aid to individuals or groups who cannot support themselves.” Investopedia goes on to say that Welfare is supposed to be temporary and the goal is to get people off of Welfare.


MediCal is, by definition and any other measurement, Welfare. The goal should be to get off Welfare. It is obvious the author of this Op Ed piece doesn’t understand this definition and does not feel the need to get off MediCal. If she doesn’t think it is Welfare, she doesn’t see a need to get off it.


Now what about Health Insurance? Insurance is a business where a group of people pool their money to share the risk of a catastrophic expense (car insurance, fire insurance, health insurance are all the same). If the cost of insurance is perceived as too high for the risk, the customer won’t buy the insurance and the insurance company will go out of business. If the cost of insurance is too low to cover the claims against the insurance company, the insurance company will go out of business. Therefore the insurance company must balance the cost versus the potential liabilities (that’s what an actuary does). This applies whether the insurance company is “for profit” or a “non-profit”. Ideally the customer would never want to collect on a insurance policy because that means he/she didn’t suffer a loss (or an illness). For an insurance company to have any chance of success, it needs to define what it is insuring and what it isn’t.


The author of this Op Ed piece is trying to convince all of us that health insurance companies should be forced to cover CAPD. I researched CAPD and decided that I don’t think I would want to pay for insurance coverage for it. Obviously the insurance companies came to the same conclusion. If someone else feels like they need insurance to mitigate the risk of CAPD, that’s fine with me. But please don’t force me to pay for such insurance.


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Representative Alan Grayson of Florida stated it precisely.

The Republican / ‘conservative’ plan for health care is simple:


DON’T GET SICK !


But if you do get sick, and can’t afford treatment:


DIE QUICKLY !


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My plan for health care is for doctors to make a decent living, patients to pay their own way, patients to make sure they save money for doctors visits and to pay for insurance for unexpected and uncommon health emergencies, for insurance companies to have competition and to have various policies that meet the needs of their clients, for insurance clients to have the freedom to choose which policy meets their needs best, for state insurance commissioners to make sure insurance companies are honest and provide the insurance they contract for, for government to constantly explore how to lower the cost of health care, provide incentives for people to save for health care and to use health care services wisely, and to provide prudent research and health advisories (think CDC here), and for those on Welfare (MediCal) to have a verifiable plan to get off Welfare and if they don’t, they loose coverage (probably not going to happen, but hey I can dream).


So where do I fit in? Am I a Democrat or Republican? Or something else? (Please be polite when you answer)


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I don’t know what you personally identify yourself as. You could be a Mugwump or a Whig, but what does it matter? It’s irrelevant to the conversation.


Your complicated construct is full of ‘ifs’, providing plenty of gaps for people to fall between the cracks.

The USA is the only advanced, industrialized country that has based health insurance on employment. For that, we have one fourth of the population that has been uncovered or underinsured; while the cost of our health care system is double the rate per capita than any other nation.

We’re 37th in the world; where all of Europe, Japan, Singapore, Costa Rica, Cuba, Canada, Australia, New Zealand …I could go on, all having better, modern, affordable systems and outcomes than ours.

Only the poorest backwater states do worse than us.


Obamacare is a step, but we need a national, single-payer, non-profit, universal Medicare for all plan.

Something like former president, Theore Roosevelt ( Republican ) first proposed in 1912..


Until then, you really can’t count the United States as one of the civilized nations.


You are critical of ‘welfare’, yet welfare is mentioned specifically in the Constitution.. In it, it is stated that one of the primary functions of our ( at least theoretical ) republican government is “to promote the general welfare”.

Well – fare.

What you advocate seems to approximate the broken and unworkable system already in place …a system that can only be described as Sick – fare.


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Medical is indeed Welfare. When Big Daddy Government is paying for you…then Big Daddy Government gets to say what it will and won’t pay for….it’s the trade off for the handout. Now the point of this article should be why is Big Government Health Care screwing you, yet you take the bait and attack the Health Care Insurance Industry which is JUST following the Rules set forth by the Big Carling and Loving Government.


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Just read about APD on Wikipedia. I can understand why insurance companies don’t cover this. ADP is such a general term with too many “maybe’s”. There also appears to be no definitive way to prove it exists except for meeting certain “characteristics” (which could also be other things besides APD). I commend you for adopting the girl, however it doesn’t seem like you are financially capable of providing for all her needs. I hope you love her and support her now that she is your daughter. That, and the girls own desire to succeed, may go a long way into her blossoming into a fine young woman.


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Hi, it’s Hilary.


Thank you for reading the piece and doing some research. However, Wikipedia is NOT considered a reliable source, as anyone can add, subtract or edit.


I think you’ll find more reliable information by Googling CAPD and reading what audiologists who have been working for years with kids say about it.


I am paying for all of my daughter’s treatment costs.


Also, I am NOT asking for money!!!!! I do not want money!!!! I am simply getting the information out there that health insurance companies do not cover this.


RE: characteristics, you will find the same things said about autism and sensory issues in

children 30 years ago.


Thanks again for reading my piece! :)


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I’m sorry, and I don’t mean to be crass, but asking for someone else to pay for something for you IS asking for money. Having “insurance” cover something is, indeed, having others at the very least pitch in (shared burden).


The problem with detaching ourselves from the cost of things, promotes all kinds of issues that often ends up wasting resources (time & money). This is a general statement for any kind of “the government should pay for that” mentality. For instance, the more money government throws at schools, the more is wasted, the higher the tuition, etc. Similar for medical issues. If money is “made available” (using dopey government lingo), then you better believe people will be lining up to spend it, and how wise are we when spending money that is wholly not our own?


Do you have no family support network? Friends, congregation, etc?


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Sorry, forgot to include your quote:

“So, I created an online petition to demand that children with these physical impairments be covered by health insurance companies.”

(showing you asking for money)


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Do you accept Medicare or Social Security ? ( NO, that is not ‘your money’…S.S. is a balance transfer program, i.e. someone else’s money ).


If so, please reject it now, or deny it when you become of age.


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You lost me at “MediCal”.


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Hi, Hilary here…


Just as MediCare is health insurance for those over 65, MediCal is health insurance for the oworking poor. Of course, most middle class families I know are on it, too.


For me to go on my husband’s insurance policy (through his work) would cost us an

extra $1300 per month.


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First, Hilary, my sympathies for your family. Any parent wants the best for their child. We have a bigger problem, in my opinion, in the U.S. with all the government entitlement programs. It costs $1300 per month for your health insurance because that is what the insurance company determined it costs to cover their risk to insure you. It costs MediCal at least that also. However, who pays for MediCal? If you and your husband don’t, who does? I think that is a big reason for much of the push back you are getting on this.


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HI, it’s Hilary…


I have to disagree with you on this one. Insurance companies are greedy, which is why they charge what they do. They will do their best to NOT pay claims as well! Private insurance companies overseas are non-profit, and do a much, much better job of caring for their citizens… at a much cheaper price.


Also — ***I** work, so does my husband (who has Blue Cross), so, I guess I’m paying for it out of my taxes, just like you do. :)


I am NOT on welfare!!!!


I am NOT asking for money!!!!


Just trying to let folks know that health insurance SHOULD be paying for these costs – ALL health insurance companies.


And yes, the US does offer MANY entitlement programs — mostly, billions in

subsidies to oil companies! And Wall Street! And bankers! THAT is another

Opinion piece.


Also, my kid is one of the sturdiest kids I know. We have used MediCal VERY

little, and I have not used it at all.


If you know someone on MediCare, that is also a government entitlement

program.. :)


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Ok. I just took a deep breath. I will go slow here. If you are on MediCal and you receive medical treatment that costs thousands of dollars, where does the money come from? Answer – the Tax Payer. Not you. Do you pay thousands of dollars in taxes? No? Then where does the money come from? Other tax payers, but not you (people like me, actually).


As far as an insurance company goes, it is a for-profit business. One of the highest paid positions (besides the CEO) is the mathematical actuaries that determine how much a risk is going to cost and how many people will actually collect on that risk. If you throw in “pre-existing conditions” without a waiting period, the cost skyrocket (think Obamacare here). It is simply (but not simple) math. If you include every single acronym for a medical condition that someone comes up with without definitive scientific research as to what it specifically is and whether treatments actually work (which is the case for CAPD) then costs SKYROCKET. That’s just the way it is. So, what you are really asking for is that everyone pay a higher insurance premium just to cover your child. Your child fortunately doesn’t have an acute illness that is threating her life. She doesn’t have a totally disabling disability that prevents her from functioning. Yet you want the insurance company to spend thousands of dollars for treatment that isn’t definitively proven and thus drive up the cost for the rest of us.


Let me conclude that your letter is actually very informative for those wondering why health insurance costs have become so expensive. Life just isn’t perfect all the time. And unfortunately even if the rest of us were to provide you with unlimited funds, it probably wouldn’t make much of a difference. The funds that would go to your daughters treatment would not be available for someone’s child with cancer or some other life threatening disease. Yet I get the feeling that you really haven’t considered that.


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Actually, we pay a lot of taxes, too. I can look at my husband’s paycheck and see how much goes out!

As a country, we need to learn to care of each other, and also realize that for every action, there is a reaction. If my daughter did not receive treatment, she would not be able to completely function to her highest capacity as an adult.. and therefore, not pay the taxes she should pay. There are a LOT more children with learning differences than deaf and blind kids, and I am more than happy to pay for their needs. I am not as happy to pay for pointless wars with my taxes, but, I do. Also, what do you think of MediCare paying tens of thousands of dollars to end of life care? Those are YOUR taxes as wel. I believe that the biggest MediCare costs are for those in the last six months of life. Also, in the end, you are paying MUCH MORE in taxes by paying for people in prison– 70 PERCENT of them have undiagnosed learning differences.

We also have a fundamental disagreement about insurance: it should NOT be a for-profit business. Health insurance companies overseas, in fact, break the law if they are for-profit.

Thanks, again, for reading the piece. As Americans, we have the freedom to agree to disagree with each other — and for that, I am grateful.


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A better estimation of taxes paid is when you do your taxes before April 15th (for most); everyone has something WITHHELD. However, withholding and paying are two VERY different things.


I do taxes for many friends and family members who make very little (under $30K / year), and most get MORE back than they had withheld due to EIC and all the federal “credits” (California stops at $0 – you cannot go into the negative, like you can with the Fed).


Sorry, did not mean to derail this discussion into a tax issue.


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if you were a defense contractor you could have whatever you ask ,your children’s children would pay the interest on the debt for you! too bad for you being married to a workingman.

maybe someday after we defeat the commies there will be enough for the kids with complex problems until then.


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Medicare is classified as an entitlement, as is social security, however, we pay our entire working lives for Medicare (1.45% from employer and employee of every penny we earn) and Social Security (6.2% for both employer and employee). The government has mismanaged and wrecked both of these programs, however, that’s for another discussion.


Medical is California Medicaid welfare program. They are not the same.


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If you are paying $1300 a month, you are a fool. Shop around rather than being the victim.


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I am NOT paying $1300 per month! THAT WOULD BE NUTS!!!!


I do have a neighbor my age, on the cheapest individual health insurance

she can get, at close to $1000.


When I “shopped” on CoveredCalifornia.org, it brought up one thing for me: MediCal.


My daughter was on Healthy Families (yes, with a monthly premium) for YEARS, until the department was disbanded by the State of California — and everyone who was on Healthy Families was automatically transferred to MediCal.


Thanks! :) Hilary


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Thank Obamacare for that!


I will not go into how the ACA was designed for a select few insurance giants with close ties to the current administration and ruling political party (actually, both parties); needless to say, Obamacare was NEVER about helping the little guy (or anyone). Sorry you (and everyone else) have to experience that first hand.


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Individual policies can easily cost this much and more. The cheapest insurance that I could obtain was $1450/month. I have diabetes and I have had two spinal surgeries. Any less expensive policies had exclusions for preexisting conditions or waiting periods or extremely high deductibles and copays.


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Thanks SLO_Johnny! I think that a great many people–especially thos fortunate enough (and the numbers are dwindling) to work for an employer who pays for their insurance, or those on MediCare, do not realize the cost of health insurance these days. This is why we need universal health care — another Opinion piece!


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Cowtipper (by the way, did you ever really tip a cow? I always wondered if that really worked) she is not a fool. She did shop around. She just stopped shopping when she found something for free. Now she is upset because her free insurance doesn’t cover something that might raise her daughters grades from B- to an A, even though there is absolutely no scientific proof that if the insurance company paid thousands of $$ that her daughters grades would improve. The real question, though, is whether a health insurance policy should be made to pay for someone’s grade improvements.


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Why are you on medical welfare? Several have asked and you have avoided the topic. I think you’ll be surprised what some companies will do for excellent employees. I, for one, would love to see you in such a company and happily working independently for your daughter’s care. My taxes are quite high enough and I’d prefer to see everyone move off of welfare if possible. Make sense?


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Hi, it’s Hilary.


I am NOT on welfare! I pay taxes just like you!


Do you know what MediCal is? It is health insurance for the working poor and working middle class. I work part time.


When I applied for health insurance under the Affordable Care Act (aka Obamacare) and listed my income, I was automatically put on MediCal.


I had private health insurance for years before this (before the ’08 crash) and my daughter was on private health insurance to the tune of nearly $200 per month in premiums… and I

can tell you that insurance paid for hardly any costs, not even her yearly physical (Blue Cross Anthem).


Also, please understand that *** I AM NOT ASKING FOR MONEY ***!!!!


I simply want to get information out there about learning differences, and the fact that health insurance companies do not want to pay for diagnosis and treatment — much like the

1970s, when autism was not covered.


My daughter is now getting treatment. :)


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Hilary,


Amazing isn’t it? Try and talk about a very real issue, one that is affecting you and your family in a very real way and the only real response you get is about being on “medical welfare”. JEEZ! One poster, TaxMeAgain, even goes so far as to imply you are either not an excellent employee or with a company that’s not! Doesn’t know you personally, has no knowledge of who you work for but will pass on his or her implied judgement in a heartbeat!


Psychological issues are as real as any physical one(s), can be as debilitating, have a direct effect on ones physical health and come with one thing that physical ones most often don’t; the often selfish, ill-informed/misinformed prejudices of others! You and your child are suddenly a direct burden on them, GOOD GOD! And if they really had their own way? You and your family would have no where to turn!


We, as citizens in the country that is suppose to be at the forefront of human rights in this world, one that preaches what is right and wrong to the rest of the world and will go to war at the drop of a hat over such issues in most parts of the world, WILL NOT take care of its own, with the blessing of a large portion of its population! Bitch about it? Say that it’s something a real moral population wouldn’t put up with and the most often response is? “Well, if you don’t like it MOVE!”


I hope and pray for the best for you and your family, but I will ad a bit of advise: Don’t try and educate the population of this community and include your personal financial challenges as you will only garner the wrath of most of it…


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Thank you so much. You get it! :)


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Hilary,


“UnitedHealth may have been among the medical insurers who feared the rising medical care costs and increased liability expected from implementation of the Affordable Care Act, but the nation’s largest insurer cited “sales to individuals and smaller employer groups” as a contributor to its enrollment growth at the end of 2013. The company added 4.5 million customers in total last year and its revenues increased 10.7% …” Forbes


This is almost true across the board with health insurance companies, and their corporate officers pay? Up almost 20% since the ACA implementation! This is the largest only REAL problem with the ACA! But the weak minded, right leaning community would have you believe you and your son are! Anytime you have business who’s profits ARE based on the ills and misfortunes of others, or more accurately on denying or limiting services to those who are ill and unfortunate, THERE IS something morally wrong! And those who see this as acceptable as part of a “free market system”? They have no moral compass what-so-ever and should just keep quiet when it comes to their prejudiced opinions of you and those like you!


I wish there was some direction or advise I could give you but there isn’t; there is a large national support group for CAPD though and maybe they can be of some help and offer you some support that this community seems to think you and your child doesn’t deserve…


http://www.capdsupport.org/


Good Luck and God Bless You and Yours!


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Hilary,


Transitions Mental Health in SLO takes Medi-Cal…


http://www.t-mha.org


Give ’em a call as I’ve heard they do an excellent job with the resources they have and are extremely good with kids!!!


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Thank you. But NO insurance company pays for treatment of CAPD or any other learning difference treatments.


My daughter is getting wonderful treatment now… :)


The point of my piece was to educate people about learning differences.


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GBG …Excellent comment !

Stupidity, callousness, and greed …those are the values that define America today They are conditions that are seemingly incurable.


Moving to a more civilized nation would be advisable, but way too many do not have the financial resources for that either.

So, most are condemned to somehow survive amidst a land of willfully ignorant asses.


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Hilary…..I feel your pain. my son has Friedreichs Ataxia ( only 5000) in the US. we pay private but were told supplemental medi-cal would cover what private wouldn’t and also help us with IHSS. for a medical based nessicity program….my son was denied. the people in the lobby with sleave tattoos and ipads for their children needed it more. by the way. I’m still paying for insurance


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Hilary, Medical is “medical welfare.” Please just accept that. Working part time, with income as you stated, I can ASSURE you that you do NOT pay taxes just like me. I hope for the best for you. I did not imply that you were not an excellent employee, as some others have said, I only want you to know that some companies take really great care of their employees. Work hard and get rewards…it works for me at least.


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