Paying for Autism Services
Parent Q&A
Archived Q&A and Reviews
Insurance Advocate for Autism Related Therapies
Sept 2013
Can anyone recommend an insurance advocate to pursue insurance reimbursement of money we have spent out of pocket related to our son's autism? Since insurers were required to pay for autism therapies starting July 1, 2012, we have spent at least $10,000 out of pocket on a developmental pediatrician, OT and social skills group for our son. We will spend close to another $10,000 in the coming year. Our insurer has denied our claims. We both work full time and don't really have the administrative capacity to pursue this. Thank you in advance for your recommendations! Really? Denied?
Try contacting Kristin Jacobson at Autism Deserves Equal Coverage http://autismdeservesequalcoverage.com/About.html or Karen Fessel at Autism Health Insurance Project http://www.autismhealthinsurance.org/about-us . Also, the new options through Obamacare may help you out...insurers can no longer deny kids for pre-existing conditions and can only charge a ''sick'' kid twice as much as a ''healthy'' kid, so you might be able to find better coverage. best of luck
I once lived in a rural town where the closest in-network primary care physician was 42 miles away. I worked towards getting a gap exception with my (very nice, employer-sponsored PPO) health insurance so I could see the primary care physicans in my town instead, but after countless hours of back and forth with various departments on the phone, it was clear the system was not made to handle this type of situation and it was so rarely pursed that no one knew how to help me. Given you don't have alternatives, I would still try to get the gap exception, but go in knowing it can be a long process, carefully document each step and take down the first and last name and number or phone extension of each person you talk to (sometimes the phone tree will randomly hang up on you and you have to start over). Perhaps consider seeking a professional that works over video call.