We’ve officially reached another waiting game.
At Kay’s most recent appointment, we spent more time going over her ADHD symptoms and discussing everything we’ve observed over the past several months. This wasn’t just based on my observations at home. We also provided the completed questionnaires, including the survey I filled out, feedback from Kay’s ABA team, and personal notes from her therapists outside of ABA. It was really important to me that the doctor had a complete picture of how Kay functions across different environments and with different providers.
After reviewing everything, the doctor shared that he feels Kay definitely meets the criteria for ADHD. While this isn’t something that came as a surprise to us, it was reassuring to hear that all of the information from the people who know Kay best painted a consistent picture.
Because of that, he once again submitted a request for the chewable medication we’d like to trial. The plan is to start with just one dose each morning and do a short trial for about two weeks. The goal isn’t to immediately find the perfect medication or dosage. It’s simply to see how Kay responds. Does it help her focus? Does it make learning easier? Does it reduce some of the challenges she’s experiencing throughout the day? Those are the questions we’re hoping to answer before deciding whether this medication is a good fit or if we need to explore other options.
Based on the additional documentation and the doctor’s confidence in the diagnosis, he felt optimistic that this request would finally be approved.
Unfortunately, that wasn’t the case.
As we suspected might happen, insurance denied the medication again.
Thankfully, the process didn’t stop there. The doctor’s office has already submitted an appeal on our behalf, so now we’re waiting once again to hear whether the insurance company will reconsider their decision.
It’s frustrating because it feels like we’ve done everything we’ve been asked to do. We completed the paperwork. We gathered observations from multiple professionals. We attended the appointments. We answered the questions. We documented behaviors. We followed every step of the process, yet we’re still waiting for permission to simply try a medication that could potentially make a meaningful difference in Kay’s daily life.
One thing I’ve learned over the years is that advocating for your child often requires just as much patience as it does persistence. Sometimes the biggest hurdle isn’t finding the right treatment. It’s getting access to the opportunity to try it.
What’s a little ironic is that we’re already supposed to follow up with the doctor soon to discuss how the medication is working. If you’ve dealt with insurance before, you probably know why that makes me laugh a little. At the rate things are moving, there’s a very real chance we won’t have even started the medication before that follow up appointment arrives.
Of course, we’re hoping the appeal moves quickly and that we’ll finally be able to begin the trial before then. It would be wonderful to have some real feedback to share at our next visit instead of simply saying we’re still waiting.
For now, though, that’s exactly where we are.
Waiting.
Waiting for insurance to review the appeal.
Waiting to see if they’ll approve what the doctor believes is an appropriate next step.
Waiting to find out whether this medication might help Kay in her everyday life.
As hard as it can be, we’ll continue taking things one step at a time. We’ll keep advocating for Kay, asking questions, following up, and doing everything we can to make sure she has access to the support she needs. Hopefully our next update on this journey will finally be about starting the medication instead of waiting for permission to do so.