How My Boy Kicked Autism
Chapter 9 Insurance
My Boy Blank (Still 30 months)
Well Blank…Road Block #1 today. I just got a letter in the mail from the insurance company. They have denied my request for evaluations claiming that speech therapy and occupational therapy are not covered services. Blah Blah Blah. Melanie said that we can and must appeal because insurance companies are required, under AB 88, (TRANSCRIPT AB 88) to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses, including autism, under the same terms and conditions applied to other medical conditions.
Melanie also urged us to get involved and track what is happening with Autism reform law in California. http://www.autismvotes.org/site/?c=frKNI3PCImE&b=3937859
I am going to file an appeal tomorrow. I can’t believe what insurance companies get away with. Meanwhile, Melanie’s office just emailed me a list of providers, including licensed speech and language pathologists and occupational therapists that specialize in treating children with autism. Her email explained that under the current state of the law (AB 88) even if the appeal is successful, our insurance company may not provide us access to professionals with adequate training or experience in autism. I am going to appeal but I am also going to bring you to get a private speech assessment and a private occupational therapy assessment. So far, the first assessment I paid for has already paid off in terms of giving us both hope and direction. And the direction it says to go in is to get these assessments. I will get those set up as soon as I get your new therapy schedule- you are not missing a single minute of a single session.
By the time the speech and occupational therapy evaluations were completed, Blank was almost 3 years old. He was making significant progress in his in-home ABA program, such that AAA recommended that the level of services be increased to the research supported amount of 40 hours per week of direct ABA therapy. As Blank’s abilities increased, so did his need for greater intensity. The independent speech report recommended 4 hours of weekly individual speech sessions. The occupational therapy report recommended 2 hours per week of clinic-based OT. Dr. Bank re-assessed Blank and her recommendations were consistent with the above.
“As long as medical insurance is provided, it must include coverage for necessary intervention services for children with autism, including services such as behavior therapy, occupational therapy, speech therapy and physical therapy. That being said, insurance policies are abound with loopholes and there is much debate over what services are medically necessary for the diagnosis and treatment of autism. California is one of many states currently working to reform autism insurance law, however, eight5 other states already have laws requiring private insurance companies to cover autism related services, including behavior therapy.
While California is working on insurance reform, the California Legislative Blue Ribbon Commission on Autism supported SB1563, which was vetoed by Governor Arnold Schwarzenegger on September 27, 2008.”
To get involved with insurance reform, please visit:
http://www.autismvotes.org/site/?c=frKNI3PCImE&b=3937859