Guaranteed Healthcare

My handsome boy Ethan was born on March 26, 2002. He was perfect from the day he was born then I realized he was not meeting his physical milestones by age of 9 months. Since he is my first born, I thought he was just a slow bloomer. His pediatrician at that time also said not to worry.

I started getting worried when he doesn't crawl by age of 12 months. We changed our pediatrician started immediately on physical therapy (Our insurance refused to pay for therapy). My son started walking after six months. But then we realized that he was not talking at age of 2 1/2. We had series of specialists seen him and finally the developmental pediatrician diagnosed him with PDD-NOS,and he started on school based program (PPCD). Then his teacher suggest that it would be beneficial for him to get private speech therapy sessions as well. We got an agency to see him at home for speech therapy which our insurance later denied because they said I could have taken him to the center.

So we just paid everything out of our pocket and started him on TX children's hospital speech therapy program which they said they would pay for. Now the insurance is saying that it is not medically necessary and that they are denying payment. We are in the process of appealing but meanwhile, we are continuing our speech therapy sessions and paying for it from our pocket. It is costing us $99 per session with the discount and once a week. His developmental pediatrician proposed three times a week of ST, three times a week of OT and three times a week of PT which we can't afford right now.

There is a little girl at the clinic who is receiving five days a week of ST, OT and PT and it is being paid by Medicaid. They said, we can't qualify for Medicaid because we earned too much for that. There is insurance also for low income families at TX children's  hospital and the social worker said we earn too much for that also.

I am an RN and my husband works for oil exploration here in Houston. Sometimes, I just wish I could quit my job so that I can do all the therapies myself at home for my son but we need two incomes to pay off our student loans and other bills. I am thinking.....Is the U.S. encouraging people to earn less so that they will be qualify for welfare and Medicaid? Is our great country discouraging the citizen not to obtain education and have a job and live the American dream? Do middle class people have to drop through the loopholes of this ridiculous system?