Help Isn’t Always Help: When Insurance Calls About Your Special Needs Child
Trusting Your Instincts and Keeping Your Peace of Mind
I’ve learned to trust my gut. As a parent of a child with special needs, that gut instinct often kicks in before the facts arrive. So when I got a call out of the blue from a nurse with our insurance company—Blue Cross Blue Shield—my alarm bells started ringing.
She said she was here to help. I didn’t know what her angle was yet, but I’ve been down too many bureaucratic hallways to assume every friendly voice is just that—friendly. Especially when it’s tied to a company that saves money when you’re either “well or dead.”
My son has been to the ER twice in two days last month. One visit was for stepping on a rusty nail. The next, a terrifying accidental overdose—too many children’s gummies designed for mood disorders. If you’ve lived this life, you already know: these moments are exhausting and blurry. You’re in crisis, then in cleanup mode, then right back into survival.
Now I’m getting follow-up from an insurance nurse.
I should be grateful. But I’m also suspicious. And here’s why.
The Bigger Picture: What Insurance Companies Are Really Doing
Based on how these systems usually operate, I came up with a few plausible theories:
• Case Management Outreach: A real program that connects families to services—but it also quietly aims to reduce costs and keep you out of the ER.
• Cost Containment: Repeated hospital visits cost insurers money. A “check-in” may actually be a way to nudge you toward lower-cost care or to discourage expensive follow-ups.
• Behavioral Health Flagging: Accidental overdoses in kids can trigger internal red alerts. They may want to know you’re “connected with resources,” even if those resources are outside their network.
• Data Collection or Future Denial Defense: If you don’t respond, they may note that. If you do respond, they’re recording that too. It’s not just about care—it’s about liability, patterns, and control.
So What Did I Do?
I trusted my instincts. I didn’t call back. I didn’t answer the second time either.
Because here’s what I’ve learned:
• You don’t have to engage.
• You won’t be penalized for protecting your boundaries.
• Coverage doesn’t disappear just because you ignored a nurse.
• Sometimes, saying nothing is actually the most powerful response.
What You Should Know If You Get That Call
If you’re in this strange territory, too—where Medicaid, SSI, and private insurance all seem to be fumbling the ball at once—here’s what I’ve learned you can do:
1. Ask who’s calling, and why. Get their department, job title, and whether it’s part of “case management.”
2. Document everything. Always.
3. Say no, if you want to. Or say not now
4. Trust your gut. It’s there for a reason.
They said they were calling to help. But help isn’t always help—not when your child’s struggles are data points, and your pain is a potential liability.
So yes—I used my instincts. And they were right. Again.
If you’re walking this path too, know this:
Your child is not a statistic.
You are not a checkbox.
And no one gets to play gatekeeper to your intuition.