Problems with Insurance Reimbursement

Question

My son has Aspergers, and I am having problems getting my insurer to pay for specialty medical treatments that should obviously be covered. Do you have any suggestion?

Answer

Unfortunately, this is not uncommon. I have found that parents with Aspergers (high functioning autistic) children not only have a tough enough time locating a good referral for either diagnosis or treatment of the disorder, but they also have problems with insurance reimbursement.

Sometimes, parents simply need to do some good old fashion “ranting and raving” to get things done – seriously! When parents are in HMO's and they are only offered low level assistance by therapists who don't know about Aspergers – it’s time to get tough.

Find out who in your area is an expert on Aspergers and demand that your insurer pay for that person (even if they are out of network). It’s up to YOU to make sure your insurers will pay! If you are in the U.S., ask your State Insurance Office to help you. Keep notes on all phone contacts with your insurer (always ask the name of the person you are talking to), and if you are getting nowhere, file a complaint with the State Insurance Office.

The Aspergers Comprehensive Handbook

3 comments:

  1. I work in the insurance and benefits consulting industry, and I have a son with Asperger's. We did not have any issues with our insurance company in providing reimbursements for therapy visits and testing. You need to make sure that the correct diagnostic codes are used. With respect to "specialty medication", this term is often used for injectable, or biologic drugs, which are very expenseive. If the drug prescribed is for "off label" use -- meaning that it is being prescribed for a condition that it was not originally intended -- or if it is "experiemental" unfortunately, most insurance carriers will not cover it. You may want to check with your therapist for alternatives.

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  2. My 17 year old son who has aspergers , I'm a single parent finding it hard to deal with him, I dont get any support and Ive tried all the things that dont work... he has low self esteem and hasnt left the house or hardly his room for nearly a year... the mental health system said the only place they could possibly put him in is a mental heath unit.

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  3. I adopted 2 boys with Aspergers and HFAutism and they will both be on Medicaid till age 18. Medicaid won't cover all the therapies and groups they need, so how do I go about that?

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