Autism and Insurance

I totally forgot to blog about this yesterday, but Erin Kiernan on TV13 is doing a 3-part series on Autism and Insurance this week. (The first segment aired last night and can be viewed here. Sorry I cannot post this directly to my blog. Scroll to the video portion and click on Investigation: Autism & Insurance). This new piece comes at a very appropriate time in our journey because we recently received our first insurance denial letter last week and I’m sure there will be many more to come.

Gav’s speech teacher at school told us that due to the large number of students she sees in a week, we should probably consider getting outside speech therapy for Gav. That sounds good. What could be more beneficial than a private tutor once a week? Well, I called our lovely insurance company who has been pretty good to us thus far (remember we even got a reimbursement a while back) and was flat out denied on the phone. The lady wasn’t rude, per se, but she wasn’t really sweet about it either. (Think she gets that question a lot from parents with autistic children? Personally, I think she’s sick of the phone calls).

I then called ChildServe (a private organization who works with special needs children). The sweet lady there called our insurance company for me again (she knew better lingo) and was also denied on the spot. A few days later, I then received a very official letter from our ins. company stating: “In your case, speech therapy is a specific benefit exclusion as treatment for disorders relating to learning, motor skills, communication, pervasive developmental conditions such as, but not limited to, autism“…blah, blah, blah. It goes on to say, “The reason that this request is not approved is expressive language disorder falls under developmental delay and is a specific benefit exclusion.”

Now we begin the appeals process. The lady at ChildServe said the only thing we can do is to continue to appeal. She said some of her clients have actually had luck doing so. Just one more thing for me to add to the to-do list. The down-side is that speech therapy is EXPENSIVE if not covered by insurance, but I don’t really feel like it’s something we should deny Gav of. So, there goes Christmas. Detox spray and speech. Woohoo!

In other news, the new bedtime routine did NOT go well. Josh was gone and the boys joined forces. We’ll see what happens tonight when he’s home to lay down the law.