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Problems with Insurance Reimbursement


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?


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


Peter said...

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.

Anonymous said...

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.

Chelsea said...

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?

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

Older Teens and Young Adult Children with ASD Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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to read the full article...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...