Puzzled4Autism: Insurance coverage - a BIG missing piece

2009-02-24T18:15:00.000-08:00

UHCCF Grants for Medically Needy Children

(per FEAT of Louisville email)
As a Board member of the United Healthcare Children's Foundation (UHCCF), I am writing to all of our BB&T Insurance Clients who I believe have contact with children, and particularly children with medical needs. The UHCCF grants money to families who have health insurance, but due to a child's medical condition, may need additional financial help to secure all needed medical care.
Robin Davis has asked me to send you this email to encourage you and your staff to spread the word about UHCCF to families who may need assistance and who may qualify. The process is simple: an applicant just fills out an application online at www.uhccf.com. If our Regional Board approves the grant request, we pay the provider directly for services provided. The maximum is $7,500 lifetime per child.
In 2008, we granted over $600,000 to families in this region. Our regional cash fund is currently just shy of $1,000,000 and the average grant is $3,000. These grants are so important to the families and children of our community. Please assist us in getting the information out and help us grant these dollars to deserving children.
Thank you for your business and the wonderful job you are doing with our community's children.
Bill Roby Sr., CLU, ChFC Vice President/Agency Manager BB&T Insurance Services

The staff of Parent Outreach and the entire Council are here to help families through the life of their child with disabilities. Please call us with questions and concerns! Phone: (502) 584 1239 email: slawrence@councilonmr.org or aramser@councilonmr.org.
Parent Outreach - Council On Mental Retardation 1151 So. 4th Street - Louisville, KY 40203(502) 584 1239

2009-02-06T05:48:00.000-08:00

Autism Speaks is pursuing autism insurance reform in over twenty states across the nation, including Kentucky!

Today, Autism Speaks is announcing its support for Kentucky House Bill 190, also known as the autism insurance reform bill. This legislation would require private health insurance companies to cover the screening, diagnosis, testing and treatment of autism spectrum disorder (ASD). Sponsored in the Kentucky House by Representative Scott W. Brinkman (R-32), the autism insurance reform bill includes coverage of Applied Behavior Analysis (ABA), an evidence-based, medically-necessary autism therapy.
Eight states – Arizona, Florida, Louisiana, Illinois, Indiana, Pennsylvania, South Carolina and Texas -- have enacted autism insurance reform legislation. Several other state legislatures will vote on similar legislation during the current session.
Your help is needed to generate support for the autism insurance reform bill from your Kentucky representative...
HOW CAN YOU HELP?
1. CALL Y OUR KENTUCKY REPRESENTATIVE! Tell him/her that you support autism insurance reform bill (HB 190)! Tell him/her that you need their support for the autism insurance reform bill. And tell him/her that the autism insurance reform bill will help thousands of families across the Commonwealth handle the financial burdens of having a child with autism. Make sure to share your family's story. Let your representative know that autism is treatable! Insurance should cover the treatment!
Find out who represents you and their phone number here.
2. SEND AN EMAIL TO YOUR REPRESENTATIVE urging him/her to support the autism insurance reform bill! We encourage you to take the opportunity to personalize the e-mail before you click "send". Tell your representative your family's story and why passage of this bill is so important.
3. STAY INFORMED Visit the Autism Votes website and sign up today to receive alerts and information pertaining to the autism insurance reform bill.
4. FORWARD THIS TO EVERYONE YOU KNOW A far-reaching grassroots effort will be crucial to the success of this legislation. Reach out to those who have asked how they can help by asking them to support this bill. They can show their support by by contacting their Kentucky representative and by registering for action alerts at AutismVotes.org.
For more information on the autism insurance reform initiative in Kentucky, visit www.AutismVotes.org/Kentucky.

VIRGINIA !!! Covering ABA & setting a standard

2008-10-05T05:38:00.000-07:00

October 2008- Legislation has been prefiled for introduction in Virginia to require insurance coverage for autism spectrum disorders. House Bill 1588 has been introduced by Delegate Robert Marshall (R-13th District) and Delegate David Poisson (D-32nd District) of the House of Delegates. The bill will require Virginia healthcare policies to cover applied behavior analysis (ABA) and other medically necessary, evidence-based treatments prescribed by an insured's treating physician or psychologist with annual coverage for up to $36,000 a year.
Autism insurance legislation is currently being reviewed by the Special Advisory Commission on Mandated Health Insurance Benefits, which held a hearing on September 29 that was very well attended by parents and advocates from all over the Commonwealth. The Virginia General Assembly will kick off its 2009 session on January 14.
For more info on this and other pertinent issues, go to www.AutismVotes.org.

HOW TO BILL YOUR INSURANCE COMPANY YOURSELF (an overview)

2008-10-02T09:08:00.001-07:00

As we still stomach the payments to resolve a large outstanding balance left to us by our insurance , once they suddenly switched gears on ABA therapy, I am even more motivated to continue to help everyone find insurance coverage for such therapies for your own amazing child !

Most ABA therapist, as well as many Speech and Occupational therapists do not bill insurance companies on their own, unless they work for a company that has the staff and resources to do so.

How to bill an insurance company on your own, is less than clear.
All insurance companies are not the same, but they do have a uniform way to receive claims.
All medical providers must have the federally approved CMS-1500 form to complete and submit to health insurance, Medicare and Medicaid. This form isn't that easy to come by if you are not a medical provider,becuase providers order these forms in bulk quantities.
BUT, that doesn't make this impossible, thanks to the internet and pdf files !
Infact, I'll try to make it easy. Here's a link to a printable CMS-15oo insurance claim form.
Print one, make copies !
http://www.rheumatology.org/practice/CMS1500805.asp

FIRST STEP: call your insurance company and/or your benefits representative at your employer. Find out what form is needed to bill your insurance company (some companies have a special form for employees which may be easier to use, and still acceptable with the insurance company), then make them send you a blank one !! Make lots of copies to keep on hand.

SECOND STEP: ask your insurance company what else they need to be submitted along with the proper claim form. If it is a current treatment plan, initial evaluation, daily notes, make copies of all this and send it along with your claim forms.
Be sure to know if there is a prior-authorization required (probably is) and make sure to send a copy of it with EVERY claim form !

THIRD STEP: keep good records of every cent you've paid out of pocket: statements, receipts, credit card bills, any document that shows what you've paid out of pocket for your treatment.

Let me stop a moment to recap / clarify:

you will in many cases, find yourself needing to pay your therapist up front, then you yourself will have to bill your insurance company for reimbursement; this require filling out all the forms yourself and gathering copies of all required documentation; mailing to the proper claims address; doing your own follow up to check the status of your claim; demanding explanation if your claim is not paid.
a representative at your insurance company should be able to walk you through filling out the claims forms properly; or you can always ask a favor at your own doctor's office, or therapist's office, they know how to complete health insurance claims forms, and can give you a quick lesson.

FOURTH STEP: submit your claim to the insurance company with all required documentation. Remember that you don't have to bill for one date of service at a time. You can gather up documents from several dates of service and submit them all at one time (ie. you could wait until the end of the month to submit all dates of service within that particular month, just be sure that each date is listed individually on the claim form, an your supporting documentaiton (daily notes, records, treatment plans) that correspond to each date of service you are submitting.

FIFTH STEP: Be tenacious ! Allow about 2-3 weeks for the claim to be processed before you call to check status, but you should be given an answer as to whether or not there is a payment in process, if other inforamtion is needed, or any reasons for denial.

SIXTH: Remember, a denial is not an absolute. You have every right to disagree with the insurance company, request a second review, and you always have the right to speak with someone higher up in the company. Be sure that you have researched your argument: completely understand why they have denied your claim, make sure it is valid, are they contradicting themselves based on what you've been told in the past, or based on the language of your policy?

An insurance company denial should be very clear. They should be able to give you the exact language from your policy by which they have made their decision.

INSURANCE COMPANIES ARE JUST PEOPLE MAKING DECISIONS - YOU CAN TALK TO THEM, ASK QUESTIONS, REQUIRE EXPLANATIONS, GET OTHER OPINIONS, BUT THE WORST THING YOU CAN DO - IS NOTHING !

Check out this website for some great inforamtion :
http://www.autismlibrary.org/insurance/insurance.html#cpt

email me with any direct quesitons and I'll be happy to help you troubleshoot your particular situation, or post a comment/question on this blog and I'll reply ! Sharing comments & question is very helpful to other families.

GOOD LUCK !!

Conservative vs Liberal at election time. Does it matter for us?

2008-09-15T13:14:00.000-07:00

Democrat or Republican ? Doesn't really matter to me.
I want to know,
WHO WILL HELP PROVIDE SERVICES AND COVARAGE FOR MY CHILD??
I'm tired of fighting for every dollar to cover the services my child NEEDS.
Needs:
To learn how to speak. To overcome dibiliating anxiety. To function amongst others. To tolerate everyday noises without covering his ears to stop the physical pain. To enjoy foods for their taste, rather than being adverse to their texture. To just be able to tell me if he is in pain, or what it is that is scaring him to tears. (just to name a few)
FRUSTRATION ??? You bet.
A disability is pure frustration; for the person who has been disabled, and for those who try to anticipate, figure out, and provide every need.
Why do we as caregivers still have to expel so much of our energy in getting the providers and the insurance companies to just lend a hand. Our energy is needed elsewhere, and I just don't have enough to go around some days.
Most families are not asking for a hand out. We just want insurers to meet us half-way.
A couple may work 3 or 4 jobs between them, to find out that the insurance company doesn't think a child who struggles to speak, needs more than one hour a week of speech therapy.
Throw us a bone here !!

To my point:
I consider myself a very liberal Republican, but I have voted both Democratic and Republican on the same ballot more than once. I vote my conscience, and for the people I trust, who I believe to be solid leaders of good character.

I think Obama and McCain are both sensative to the plight of special needs children, special needs adults and their care givers. However I am finding great comfort in the fact that Cindy McCain has a Masters in Special Ed, and worked side by side with special needs kids and Sarah Palin watches the heartache of her sister Heather, as she raises a son with Autism.
And now, as we've all seen, Sarah Palin has her own special needs child with Downs Syndrome.

I never cast a Presidential vote based on any one issue. BUT, I am tired.
I am exhausted from having to explain to the world, why my child needs the treatment he needs, and why I need help paying for it.
Having people "on the inside" that just KNOW ??!! It's comforting. Having the experiences Cindy McCain and Sarah Palin as part of the daily life of our Commander-in-chief, could be one of the best things that has happended to our mentally challenged loved ones.
Why? Because there is no better support, nor any better activist, than other families facing the same struggles. I've learned first hand to find strength from the Autism community we never anticipated we'd be a part of. I am someone who never sought out the "support group" thing and I hate sharing with a group. But I've been forced to find solace and comfort in my community by the people who speak the same language. They know what you mean when you say "GFCF", "stimming", "proprioceptive", and "what biomedicals have you all tried?". The cast no judgement if your child is reciting aloud a script from a movie, as someone is speaking. There are no disgusted looks if you have to leave the room to change the spoiled Pull-up of your eight year old who is struggling with toileting skills. Everyone just knows, and they are on your side.

There are millions of families in the USA who are looking much deeper than just the hot topics on energy, government reform, Iraq and terrorism.
As far as this 2008 election goes, I am a special needs mom who wants to throw a bit o' Janet Jackson at Washington and say, "What have you done for me lately?"

Corny? Yes. But I don't care. I want to know that I am being heard. I want my insurance company to listen and learn. I want my husband and I to not have to work three full-time jobs between us, with other odd jobs on the side to cover my son's expenses, because insurance didn't see the need. And I want my son to one day be able to sit down with me, and tell me about his day.
Is that so much to ask??
If a Cindy McCain's and a Sarah Palin's presence in Washington can help us obtain that someday, count my vote !

STILL FIGHTING FOR ABA COVERAGE - AFTER 2+ YEARS OF COVERAGE

2008-07-06T08:16:00.000-07:00

Really, it was almost 3 years that my health insurance was partially reimbursing us for our son's intensive ABA therapy, after initially telling me it was covered. We would pay out of pocket, and they would reimburse us per our plan. This went on with no trouble for almost three years until they suddenly decided ABA was "experimental and investigational", then when I presented documentation to argue that, they decided that the ABA was provided by an ABA therapist and she suddenly did not meet their "criteria as an approved provider", even though she met their definition of a "board certified professional in her field".
Does it appear they are trying to squirm their way out of this??
After appealing their second denial, they decided to come back with, "ABA should have never been covered in the first place." Basically I interpreted this as, 'we have no intention of covering his service for your child, no matter what you come up with as an argument.'
If it truly should never have been covered, why did it go on for close to three years?
It seems to me that with the economic crunch someone just decided to look at claims which has become cumulative high and then find a way (a loophole) to deny coverage.
We've been paying out of pocket for ABA, about $1400-$1800 a month, since April 1, and the fight with insurance is not over yet. Hopefully, legal counsel will be able to advise an what our next step may be. The insurance company does have to honor our rights as an insured and they have to realize that they set a precedent which was the cornerstone of my son's treatment plan and his prognosis. We will not sacrifice his future because a greedy insurance company has maneuvered their way out of coverage. Instead we are working three jobs between us, and looking for other means of income to keep our son in the services he needs. Just like so many other families out there, desperately trying to hold on to , and bring back their precious children, from the brain thief - Autism.

Does your insurance cover Autism? I want to know.

2008-06-07T06:16:00.001-07:00

Please email me and let me know if you've been successful in getting coverage for Autism treatmnet through your healthplan. Let me know who the insurer is and the company you work for.
I'm creating a GOOD GUYS / BAD GUYS list. Obviously, the bad guys do not see the medical necessity to cover therapy or treatment for our kids, and they are in need of education and awareness. This list will help us educate those who need to understand the impact of their uninformed decisions regarding what the will or will not cover for their employees and families.
Thanks !!
email me at kelly.haysley@gmail.com

GRANT for Families struggling with AUTISM Care - ANYONE CAN APPLY

2008-06-07T06:13:00.000-07:00

Grants Available for Families Struggling with Child Health-Related Expenses
Deadline: Open - year round

The UnitedHealthcare Children's Foundation (UHCCF) has announced that new grants are available to help children who need critical health care treatment, services, or equipment not covered or not fully covered by their parents' health benefit plans. UHCCF provides grants to families to help pay for child health care services such as speech therapy, physical therapy, occupational therapy sessions, prescriptions, and medical equipment such as wheelchairs, and eyeglasses. Parents and legal guardians may apply for grants of up to $5,000 each for child medical services and equipment by completing an online application at the UHCCF Web site. To be eligible for a grant, children must be 16 years of age or younger. Families must meet economic guidelines, reside in the United States, and be covered by a commercial health benefit plan. (Not available to Medicaid/SCHIP recipients).

Go to http://uhccf.org/ for more details.

A Ray of Hope from The Sunshine State

2008-04-24T20:34:00.001-07:00

Let's hear it for Florida !!
They are now the 12th State to set an example of changing laws to keep with the needs of society. Friday, April 18, Florida legislators passed laws requiring insurance companies to provider coverage for the treatment of Autism and related disorders.
As if that wasn't a huge step, they are also requiring that education majors take a 40 hour course on ASD.
That's right. Insurance benefits, and teachers who will know what Autism is.
I've just hit the highlights of this great news. For the full article please visit the link below.
Thank you to editorial writer, Elisa Cramer , at the Palm Beach Post for bringing this to our attention.
http://www.palmbeachpost.com/search/content/opinion/epaper/2008/04/18/m20a_cramercol_0418.html

ABA is "Investigaional and experimental"? What century are you in ??

2008-04-24T20:01:00.000-07:00

Too many of us are hearing this outdated, ignorant and thoughtless phrase from our insurance companies. Why? Because the decision makers for these large, commercial insurance companies are making one of the most uninformed decisions around.

If you have already, or should you in the future receive a denial from your insurance company for your child's ABA therapy because it is considered to be "investigational and experiemental", write back! Now! Be sure to quote this line from Mental Health: A Report of the Surgeon General: "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inapporpriate behavior and in increasing communication, learning, and appropriate social behavior." Further detail on this statement from the US Surgeon General's office can be found at www.surgeongeneral.gov/library/mentalhealth/chapter3

Your health insurance company is NOT an expert on health or what you or your child needs.
Educate them. Demand explanation. Educate some more. Keep asking. Keep educating.