Insurance appeal

I figured since I’ve been absent from posting the last 3 weeks, I’d post separate entries regarding what’s been up in our world. 

One of the most frustrating issues has been a denial of insurance for ABA services due to “not being medically necessary” for our 5 year old son with autism. We buy our son his own insurance policy just for ABA services since self-funded employer plans can opt out of providing it.

Anybody with an inkling of autism knowledge should be aware that the only proven therapy to help is applied behavioral analysis (ABA). Roger began Early Intervention in California at the age of 18 months, prior to his diagnosis, and they utilized the Denver Model that includes ABA. He was in that program until we moved to Texas in October of 2013. 

The following year we were not aware of child-only policies, so he only attended PPCD 3 hours a day, had OT 1-2 times a week and Speech once a week. He did progress a little bit but nothing like he has in 2015 while attending the Easter Seals’ preschool with a BCBA. 

Of course, I received the letter on a Friday night and began freaking out. Saturday we had plans so I could only mentally obsess. Sunday was the day I dedicated to compiling my appeal.  The package that I sent in a Priority Medium Flat Rate Box consisted of over 250 pages of evaluations/observations/ADOS/IEPs. After I finished that task, I wrote letters to Easter Seals’, our psychologist, and pediatrician to fax their letters separately. 

I am relieved that it is off in the mail before the holidays!  One less thing to think about until I follow up next week. 

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