It’s Officially; The A Word.

Blog & News Timeline View

  • It’s Officially; The A Word.

    Hello All!

    I hope you all are having a great holiday! I first want to apologize for the delay of this blog post. This post will be all about my favorite 3 1/2 year old Riley; aka Riley Boy!

    Something’s going on!

    When Riley was around 1 1/2 I began noticing that he didn’t use as many words as my daughter did by his age. I expressed my concerns to my family and even his pediatrician. Everyone gave me the response that literally makes me cringe; “It’s probably nothing”. This is the same thing the doctors told me when I found a lump in my breast at age 25 that turned out to be triple negative breast cancer. That’s a story I will also share in the near future. However, you can see why these statements didn’t ease my mind.

    It doesn’t help that my family thinks of me as always fearing the worst. Again, my personal history may be a valid reason. One family member told me “I don’t want him to have a label”. My response; I don’t care about a label, I care about him getting the help he needs. My family meant will and truly didn’t have any concerns about my sons development. In all honesty I wanted to be wrong; hell I’d rather be crazy than correct. However, I couldn’t completely shake the feeling that something was going on.

    Loss of words.

    Also around age 1 1/2 Riley could and would say hello to everyone. When asked, “How are you”; he would respond, “Good”. However, around 2 he was no longer saying any of this. We would call his name and it was like he was ignoring us or just couldn’t hear. He would rewind videos on his tablet over and over again to a certain part. He wouldn’t answer question but repeat the question. If allowed he could stand in front of the mirror for hours acting out scenes from his favorite cartoons. He could do the exact moment with ever word.

    Also, his tantrums were over the top. I mean banging his head on the floor. My family wanted to get him a helmet. However; it became an argument between my husband and I. My husband believed that a helmet would make reinforce his head banging. Meanwhile, I didn’t know what the heck to do. So like most people I went to Dr. Google. I researched the signs of autism, I looked for peer reviewed articles. I also spoke with his preschool teacher and administrator. They suggested contacting the Frank D Lanterman Regional Center here in Los Angeles, CA.

    Help at last!

    After playing phone tag for a few weeks; eventually, we were able to get an appointment and see a psychologist. The outcome of the appointment was that my son didn’t have enough signs and/or symptoms to be diagnosed with autism. However, my son did qualify for speech therapy (ST/SLP), occupational therapy (OT) and physical therapy (PT), through the regional centers Early Intervention Program. Each discipline (ST/OT/PT) came to our home to do an evaluation. Based on the evaluations each discipline developed a treatment plan. Riley had ST and OT twice a week and OT once a week. The best thing about these services were that they worked with Riley at daycare and sometimes home if needed.

    At age 3 my son graduated from the Early Intervention Program and was evaluated by our school district. The regional center case manager attended the evaluation with us. My husband and I had to fill out several forms as the team evaluated Riley while playing with toys.

    The school district can not officially diagnose developmental disabilities; however my son was unofficially diagnosed with characteristics of autism. He was given an Individualized Education Program (IEP); with a treatment plan based on small short term goals. On the day after his 3rd birthday he started his special education program. He received OT, ST and applied behavior analysis (ABA) was added.

    Although Riley was making much improvement with speech; his teacher was still concerned about his behaviors. She recommended contacting the regional center again for re-evaluation. I’ll be honest Riley had improved so much at home I forgot the teacher recommended a re-evaluation. However, at school and on the bus not so much.

    Riley has Autism

    A few weeks ago I called the regional center and requested a re-evaluation. By the grace of good we were able to get in within 2 weeks due to a cancellation. The psychologist told me she will have to write an official report, (we’re still waiting on the final evaluation); but she is pretty sure Riley has Autism.

    This time I suspected this but it was still hard to heard. The blessing in this is that Riley will now qualify for additional services outside of school and get all of the support he needs. Early intervention is key in helping children with autism reach their full potential. Riley still has challenges but his progress is undeniable.

    To be continued….

    Next I will follow up with signs and symptoms of autism, important definitions and useful resources.

  • Follow me on IG @busybri_rn

    Hey All,
    Happy Thursday!!! I have to put a face with a name. I may forget the name but I will always remember a familiar face. Can you relate? Since I will mention my family, I think it’s only fair you get to see who I’m talking about. Get to know and see more of my family by following me on IG. Also check out IG for blog alerts! Thanks!
    See y’all soon!
    -BusyBri 😘

    How to find me on IG Step by Step

    Copy @busybri_rn (use the title of this blog)

    go to IG,

    paste @busybri_rn into IG search box

    select search

    Click on my profile pic

    Hit the follow button

    Look at all the pictures you can!

  • ‘Tis the season for open enrollment!

    Open enrollment for health insurance is here. I’m going to go over terms you should know before choosing a health insurance plan.

    The first thing to know is the insurance plans with the cheapest premium aren’t always the most cost efficient in the long term. My cheapness, ahem, I mean frugalness, cost me thousands. I don’t want that for you, your friends or your family.

    PPO vs HMO vs POS vs EPO

    This looks like an algebra equation, right? Anyone else feel a little anxiety when your employer hands you these insurance forms? I use to! When I didn’t know the answer on a test I would chose C. Following that same principle, I would chose insurance plan C (cheapest). Using this principle caused me to get a D; DEBT! So here’s what to know:

    PCP-Primary care provider aka Family doctor aka Medical doctor aka General doctor. People call the PCP many things; the thing to remember is it’s the doctor that you see for annual physicals, referrals, medicines, common colds etc.

    Deductible-Amount you have to pay before insurance starts to pay your medical bills.

    Co-insurance- After your deductible is reached the insurance pays part of the bill. Usually the insurance pays 80%. Leaving you with 20% of the bill to cover. This 20% is your co-insurance or cost share.

    Maximum out of pocket- AKA max oop. The most money your will have to pay for the year. Once max oop is reached you pay nothing. The deductible and co-insurance typically count towards the max oop. Premiums do not count towards the max oop. The in network max oop is less than the out of network max oop. Meaning you may meet the max oop for in network providers but still have to pay a co-insurance for out of network provides; until the max oop for out of network is meet. Another way to put is if you meet the in network oop max for the year, any provider in network will not cost you anything for the rest of that year However, if you go to an out of network provider you will still have to pay a co-insurance. I suggest verifying that both in network and out of network providers count towards the same max oop for the year. Or if there is a separate max oop for in network providers and a separate max oop for out of network providers To clarify, say you’ve reached your deductible and you go to an in network doctor. The insurance pays 80% and your portion to pay or co-insurance is $150; the $150 would be applied only to the in network max oop. There would be nothing applied to the out of network max oop. Typically your co-insurance counts toward the max oop no matter if the provider is in network or out of network.

    Referral-Certain medical plans require that your PCP write a referral before you can see specialist.

    Authorization-After the specialist receives the referral from your PCP, the specialist submits a request for authorization for the services that will be provide. The authorization is like a promise to pay from the insurance to the specialist office.

    Preventative screenings- Testing or procedures use to rule out disease. Examples are mammogram, colonoscopy, PAP Smear, prostate screening, and vaccines or shots such as the flu vaccine. Preventative screenings are typically covered 100% by your insurance. These screenings do not count towards deductible, or max oop.

    Diagnostic testing- Testing or procedure to check status of illness or disease previously diagnosed and/ or treated. For example, anyone that has had a lump in there breast all mammograms moving forward are considered diagnostic and no longer preventive. This diagnostic testing is NOT covered 100% by insurance.

    Side note: if you’ve had cancer anywhere in your body and it is found years later in another part of your body it may be considered reoccurrence. For example, any woman that has had breast cancer, of years later has lung cancer it will be considered breast cancer that has spread to lung. There are medical terms and other details but we’ll dive into the how’s and why’s later.

    PPO- Preferred Provider Organization. Plan covers both in and out of network providers. Out of network provides will cost more. Cost include monthly premium, deductible and co-insurance. There is a max oop. The pro of the plan is that a referral is NOT required. You can go see any specialist you want.

    HMO- Health Maintenance Organization Plan covers in network providers ONLY. Except in the case of an emergency. Out of network provides will not be covered by insurance and you will pay 100% of cost. There is no monthly premium, no deductible and no co-insurance. Unlike PPO there are pre determined co-pays. Meaning you already know what you will have to pay for your visit. Once you pay your co-pay you have covered you will not receive any other bills. The downside of this plan is the network can be small. Also you may need a referral from your PCP to see any specialist. Even routine specialist like the OB/GYN. Often people do not want to leave their PCP or specialist so they opt for the PPO. The good thing is typically HMO plans work with health care systems like UCLA, Kaiser, Sentara, Bon Secours and MCV. Therefore, if you don’t like the vibe of one provider you can always chose another.

    POS-Point of service. PCP is required. The plans covers both in and out of network providers.

    EPO- Exclusive provider organization. This plan does not require referrals from your PCP to see a specialist. Network of providers is similar to a HMO. Out of network providers are not covered.

    Prescription drug plans- Insurance for prescription medication is a separate entity from medical coverage. Medications have separate deductibles, co-pays and/or co-insurances. A formulary with different with 3-4 tier levels, determine medication costs or if the medications will be covered at all. Please review the medication coverage plans before making a solution. Medication coverage can get so complicated that I will have to save the details for another. Like how to get a medication that’s not on the formulary to be at least partially covered, programs to help with cost of medications (you must qualify) and how to get a tier 2 medications to tier 1 in order to lower your co-pay. It takes effort but I’ve actually done these things for my patients. So we pause for now.

    I hope that this info helps you or someone you know to feel a little less anxious when choosing health insurance. I know this isn’t the most exciting information; however, any information that can save me money excites me!

    Thanks for stopping by. I truly appreciate it. Please don’t forget to tell 5 friends to tell 5 friends to check out this blog! Please comment, ask questions, add info, tell me if there is something that I missed, a topic you want to discuss, or you can just say, Heyyyy! 🖐🏾

    -BusyBri_RN 😘

%d bloggers like this: