Insurance Companies & Autism treatments (autistic, therapy, child, kids)

[KC to NC]

A friend of mine sent me this news story.
Family Wins Case In Autism Coverage Lawsuit - Health News Story - KMGH Denver (http://www.thedenverchannel.com/health/14730526/detail.html - broken link)

It is an interesting story on Autism and an Insurance suit that was brought against an insurance company for denying payment for ABA treatment. It is very exciting to hear that the family won. The family had Anthem Blue Cross/Blue Shield PPO.

My son is getting ready to start a private autism preschool in Cary, NC for 1/2 a day, 5 days a week that's treatment program focuses on Verbal Behavior Therapy. For those of who wonder what the difference between ABA and Verbal Behavior is, here is a link that helps explain it:
Autism Intervention Information .: The difference between Lovaas and Verbal Behavior (VB) :. (http://www.autismusaba.de/lovaasvsvb.html - broken link)

My 2 1/2 year old was diagnosed only 6 months ago so I am still trying to wrap my mind around all that there is to learn about this condition and treatments available.

We have United Healthcare PPO. Have any of you out there filed any lawsuits against UHC to try to get them to pay for your child's autism treatment program or been denied certain treatments by them? I'm wondering since ABA is so well known that we may not have a shot at trying to get them to pay for Verbal Behavior Therapy. The preschool is very expensive.

I'm not sure how to attach links within a thread so I apologize if you have to copy/paste the links.

[saralee]

A victory for sure.

Sara

[Kake1223]

kc,

have you already had any communications with your insurance carrier regarding this preschool? what was there response?

what types of early intervention programs does nc offer to autistic toddlers? why are those not sufficient?

the thing with the insurance companies and government agencies is that they have limited funds and sometimes they dont care what we want our kids to have. it is ur duty as the parent to explain to them 1) why the treatment is necessary (not why it is beneficial) 2)why the duty to provide the service is their responsibility as opposed to another entity

i think a good place to start is by gathering supporting documents. have your pediatrician and neurologist write letters stating why this program is medically necessary.

in my case, since my funds are extemely limited, i always network with parents who have kids receiving the service i desire. i ask them, so who is ur neurolgist, psychologist, therapist, etc.. then i contact that specialist, let them know what service i want and why i believe my child needs it. i do that simply becuz if that specialist assisted one parent to get what i want, then it's pretty likely that they know how to write reports that can successfully assisted me to get the same services.for me, it is important to have a doctor who in addition to being a good doctor is a good writer!

in your case, should you receive a denial and have to appeal the decision then your case will be strong if, the UHC contracted doctors are on your side. and the treating physican's statements may be viewed as more compelling than a doctor they bring on simply to evaluate your child.

good luck and thanks for the info on vb, it sounds promising! please keep us informed as success stories are an inspiration to us all.

[Mom2Feebs]

You need to see if ABA is defined by your state legislature as "experimental". If so, your insurance company does not have to pay for ABA therapy.

[miranova]

I think the "Ryan's Law" just passed in SC - making sure insurance covers up to 50k/year...for ABA, i think. (I was just reading about it briefly)

The mother/lawyer who was behind it has a website that gives details about how they got it passed because they have been contacted by so many in different states wanting to do the same.

It's not enough for me to move back to SC though! hope that helps