ask your local library to retrieve the following articles:
author: svein eikeseth
title: outcome for children with autism who began intensive behavioral
treatment between ages 4 & 7: a comparison controlled study
source: behavior modification volume 31; number 3; pg 264-278
author: o. ivar lovaas & tristram smith
title: intensive behavioral treatment for young autistic children
author: john j. mceachin, tristram smith, & o. ivar lovaas
title: long term outcome for children with autism who received early
intensive behavioral treatment
source: american journal on mental retardation, vol 97 no 4 pg 359-372
author: stephen r anderson, et. al
title: intensive home based early intervention with autistic children
source: education and treatment of children vol. 10, no. 4
author: vanessa k jensen, leslie v sinclair
title: treatment of autism in young children: behavioral intervention and
applied behavior analysis
source: infants and young children april 2002
there are a ton more. you can pull other sources from the sources stated
in the above articles. that's a good place to start.
also, ask your doctor to write a letter explaining the benefits of ABA. do a
google search of ABA and print out whatever you find on the internet and
send in a package to the insurance company along with journal articles
and letters from the doctors. the surgeon general supports ABA so make
sure to include that in your info to them.
we just sent a 90 page package to our insurance company with hope to
get some coverage for ABA. if they deny it we will keep appealing until
they give us some coverage.
the more you are a pest to the insurance company the more likely they
will give in !
L
I need your help! I am trying to get our insurance to pay for MUCH NEEDED ABA!!!! It will be a fight. What is PROOF that ABA workd and helps ASD kids. ANyone have any linkds to any sites with good info showing studies,etc? I woudl REALLY appreciate it. THANK YOU!!!!! THe behaviors are getting CRAZY!!!
Tricare is the only insurance I know of that will pay for ABA therapy.. but only a board certified therapist, no other help..... Well, good luck to you!
Someone else once was desperate to find the following letter. Maybe insurance was why?
I saw on another website that you can also get it from the UCLA Dept. of Psych:
"Criteria for Appropriate Treatments," a letter by Dr. Lovaas that "is intended to address the question of what constitutes an appropriate therapeutic intervention for a child diagnosed with autism." The document is dated 4/6/95 and is available from the UCLA Department of Psychology, Box 951563, Los Angeles, CA 90095-1563."
Thank you!!!! I am looking at it now... if anyone else has ANYTHING< I would appreciate all the data I can get!bonus367-goodluck and let me know how it goes! I found this information in a sight by a Mom n CAlifornia. I dont know if
it helps or not. It does mention other states as well.
This website was created as a starting point to help California parents
obtain insurance coverage for autism related therapies, which include, but
are not limited to: Applied Behavioral Analysis (ABA), Speech therapy,
Occupational therapy, Physical therapy, etc. This is based on our personal
experience getting coverage for our son's various therapies. I am just a
mom and have no legal training or background in the insurance industry.
My statements and advice are not intended to replace your own research.
I have included copies of the documents that helped us along the way.
This may not help everyone, but I hope that it gives you the information
and tools you will need to obtain insurance coverage for your child.
Prior to your child's third birthday your local Regional Center is
responsible for his/her developmental needs, including ABA, speech
therapy and other services. After age three, the responsibility is
transferred to the local school district. The Regional Center or the local
school district may not offer the services your child needs. California
Assembly Bill 88 (AB 88) allows you to obtain services for your child at
any age. In our experience neither the school district nor the Regional
Center informed us of our rights under AB 88.
This all began when my son turned three and we had our first IEP
(Individualized Education Program) meeting with our local school district.
My son was doing great with his early intervention services and we
wanted those therapies to continue. However, our school district did not
want to fund it. Rather, they wanted to place my son in a class that was
not appropriate for him. In addition, they wanted to reduce the amount of
ABA, Speech and Occupational therapy he was receiving, even though all
of his therapist's reports recommended otherwise. Feeling very helpless
and frustrated we began searching online for anything that could help us
get insurance coverage for his therapies. I stumbled upon a website that
explained how to obtain coverage in Indiana, written by a mother who
went through the process. She explained that in Indiana there is a State
mandate that covers Autism treatment and that there are similar
mandates in California and Georgia. AB 88 mandates that Autism is a
medical condition that insurers are required to cover under the law. I was
able to follow her guide and get insurance coverage that included 25
hours of ABA a week, plus 3 hours with the program director, Speech
therapy and Occupational therapy. I have since contacted the owner of
the website in Indiana and was given permission to use the guide and
customize it to help families in California. I also attended a lecture given
by Christopher Angelo, a California attorney who explained how to obtain
coverage. He even provided a letter to send to your insurance company
and extensive information on AB 88. I have included those documents in
this website. I don't think we would have succeeded without this help.
Special thanks to Christopher Angelo for all his hard work and dedication
to this cause. He did not copyright his work, so that anyone may use it as
needed.
I do want to caution you that obtaining insurance coverage may not be an
easy road. Part of the problem is that your insurance carrier does not
want to cover these services and in many cases, as in ours, have not been
upfront about coverage and tried to deny us at every turn. Many parents
ask them if ABA is covered and when they are told "no" by their insurance
carrier, they give up. Well, I want to tell you that the law is on your side
and it is possible to obtain insurance coverage for Autism. Initially our
health plan told us that ABA is not covered and that we should seek
services from the school district (which is illegal for them to do). After
submitting Mr. Angelo's Insurance letter and reminding them of their
responsibility under AB 88 they said yes. Then they told us that in-home
services were not covered. This prompted us to file a formal appeal with
the insurance company. The insurance company denied our appeal,
stating again, that in-home services were not covered. We then filed a
complaint with the California Department of Managed Health Care. During
the course of the complaint the health plan changed the reason for the
denial several times. They eventually said that in-home ABA was not
medically necessary. We then had to file for an Independent Medical
Review (IMR). The IMR overturned the insurance company's decision, so
we now get ABA covered in our home. This whole process took us about 5
months, but it was worth the fight. I encourage you not to give up!
Other States: Based on the report INSURANCE COVERAGE FOR AUTISM by
Janet L. Kaminski, Associate Legislative Attorney in CT, "Sixteen other
states (besides CT) have insurance laws relating to autism coverage
(California, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana,
Maine, Maryland, Montana, New Hampshire, New Jersey, New York,
Tennessee, and Virginia). Of these, 10 require coverage for autism
through their laws mandating coverage for mental illness (California,
Illinois, Iowa, Kansas, Louisiana, Maine, Montana, New Hampshire, New
Jersey, and Virginia). The other six states have specific laws regarding
insurance coverage for autism (Georgia, Indiana, Kentucky, Maryland,
New York, and Tennessee)." Most recently, Oregon gained full parity this
year.
You can also find information on all State laws at: State Laws Mandating
or Regulating Mental Health Benefits
Disclaimer: I am just a mom and have no legal training or background in
the insurance industry. My statements and advice are not intended to
replace your own research.
The Bay Area ASD Advocacy Group, a group of parents of children on the
spectrum advocating for better autism legislation, are currently
investigating whether health insurors are complying with CA AB 88 (also
known as The Mental Health Parity Law).
One way to assess compliance with this law is to document the ways that
insurance companies are handling claims for clients on the autistic
spectrum. We want to hear from you about your family's experience in
obtaining health care coverage for autism related treatments. If a claim
was denied and you took it to the CA Department of Managed Care, how
did that experience go?
Please keep it brief, a one to two page summary would be ideal. Your
contact information is not necessary, but the name of your insuror would
be appreciated. We will be passing this information on to the Calfiornia
Blue Ribbon Commission on Autism. The commission is currently
developing state-wide policies on autism.
Please email information on your experiences to Karen Fessel at
karenfes@sbcglobal.net or Rachel Norton, at rpnorton@hotmail.com. Feel
free to e-mail us if you have questions.
[This website would also like to get your submissions, so we can share
them with other parents who can learn from your experiences. Please
email info@insurancehelpforautism.com if you would like your story
posted. All submissions will be kept anonymous.]
Thank you for taking the time to share you experiences.
Here's a link to an article by Jensen and Sinclair.
I looked around for a while trying to find the same thing. I'm just not ready to start fighting them until I know I can't get funding any other way. Anyways, the two sites that can give you basis that I plan on using when/if I need it:
The first is NY guidelines, you'll need to dig around a bit to get your examples. The second is a report from the US Surgeon General saying that ABA is one of the few therapies that has research and been shown to be effective. (Though it falls short in saying how much therapy a child needs. That's where the NY guidelines come in.)
I wish you luck on this. You are paving the way for so many children by doing this!
I KNEW I cAME TO THE RIGHT PLACE...YOU GUYS ARE THE BOMB!!! iT WILL BE A BATTLE, BUT WE ARE WILLING TO FIGHT !!!!!!!i WILL KEEP YOU POSTED...IT WILL TAKE ME AWHILE TO GET EVERYTHING TOGETHER. THANKS AGAIN! H
Most insurance companies will not cover ABA since they think it is not medically neccessary. Your only luck to get it covered is to live in a state where it's mandated by law. I can't remember which states have the mandates but you can do a search to find out. Good luck.
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