It has been a bit since I last wrote anything here, but we do have some news. Good and somehow bad at the same time. We got the call about a week and a half ago that a bed had opened up for my S18 AN at the facility that we have been hoping to get him into. It is local, which is so important. I feel for these parents who end up having to send their kid out of state, one parent moving to stay near their child in treatment, while the other is left behind to hold down the fort.
He was to be admitted the day after Easter, a mere 4 days away. Which led to the mad scramble to get everything done, a negative COVID test, and the referral for Tricare to approve. We went in for the test, and while there I hovered over the physicians assistant to make sure she put in the proper wording. Medical necessity. Highest level of care. Meaning he NEEDS residential, 24 hour, round the clock, supervision and care to make sure he can be well again.
Then came the waiting. COVID test was negative, of course. I was in constant contact with the wonderful admissions director at ViaMar, she made sure I knew that as soon as she knew anything, she would send word. Tricare was/has been taking their sweet time. I write calmly, but inside I am enraged.
Easter weekend passed, my son worked the majority of it, but I made sure he had an amazing Easter dinner. Friday morning, I made an Easter brunch for a few friends, I made a raspberry danish, egg souffle in puffed pastry, fresh fruit, and candy. Saturday evening we had our dinner, ham, I made a bourbon honey glaze, rolls, potatoes au gratin, roasted green beans, and my most requested homemade macaroni and cheese. Sunday we went to our friend's house, he came after work, and there was so much more delicious food. And candy, always candy. ALL THE CANDY.
I do want to mention that over the weekend we had a breakdown. Saturday night, he came into my room, to talk about ViaMar. I had wanted to anyway, as admission was only a couple of days away and he hadn't packed a thing. I asked if he had everything he needed, more comfy pants, any hoodies, anything to help him feel comfortable. This was not why he had come in. He was/is terrified. He is worried about how much they are going to make him eat, how long will he have to stay? He is imagining he will be there 3+ months, which feels like forever. There is also the issue of his phone. Will he be allowed to have it, allowed access to it maybe a few times a day? His girlfriend doesn't live near us at the moment, and the phone is their lifeline. He tried to tell me he didn't NEED to go, he could do it at home. He would get up earlier, he would eat plenty, and get well. At home.
After much discussion, I convinced him we would go in, we would talk with admissions, so he could get an idea of what was going to happen. Getting well at home isn't an option. If it was, my efforts these past 7 months would have completely taken care of the ED. He needs professional help that I cannot give him.
Monday rolled around, and we heard nothing. I was willing to give a bit of leniency as we were coming off Easter weekend. The director assured me again, that as soon as she knew something, we would be off and running and get him admitted. Tuesday came, I was getting frustrated again, so I dug around and after a LOT of effort, managed to get into his Tricare file online. Referral DENIED. I saw red. We did everything we were supposed to, I made certain the referral said all the right things. WHY?! So I got on the phone. I called Tricare, was hung up on, called back. Had to have my son give verbal consent for me to talk, since he is 18 years old. I finally spoke to someone and asked why were we denied. Tricare informed me that Viamar is not authorized for residential care. Seriously?!? We were told months ago they were, we went through hell and high water, to get referrals, to get all the information needed. We were told that ViaMar was in network, and now they were not?? I asked how could this be fixed, could we get a one time authorization? I was transferred to a higher level of authority, only to find I had to leave a message.
Everything that we have been through, the hoops I have jumped through, fiery and otherwise, only to be reduced to "leave a message after the tone".
I would be lying if I said I didn't cry. Out of anger, out of sadness. That what we need, what our son needs, was once again being denied.
A few hours later, I received an email for the director at ViaMar. She has also been told by Tricare that we had been denied. Because they were not certified for residential. I am SO thankful, that we have this woman in our corner. She was livid. And immediately jumped into action. ViaMar, has in fact, been certified with Tricare for residential care for at least a decade. They have all the documents proving this point. Calls were immediately made, and Tricare was proven to be in the wrong. They "apologized", if you can call it that, and said they would begin working on remedying the situation. Did I mention, this could take TWO WEEKS?? Two weeks, 14 days longer, of my son not getting the help he needs and deserves, because someone screwed up. His health does not matter to Tricare. It is absolutely foolish to believe that these insurance entities have anyone's best interest at heart.
We are reminded all the time, the enormity of the planet we live on. And each of us, when put into perspective, are but a tiny speck in a vast universe. Factor in the immensity of the fact that our health and lives are truly held captive by those in charge of medical insurance, and what services they deem necessary for our survival? This is the moment we all disappear.
In other words, the medical insurance gods are our Thanos. Snapping their fingers and ending the lives of those they don't regard as worthy.
