Insurance Denies Treatment for Autism

First find the right doctor. Second that does not sound like PDD, my son has PDD. PDD tends to be where they throw the younger kids because they can't tell that young what is going on. Having said that, that is why the insurance isn't going to let you bill every idea you have. Which is why I said find a good doctor.

A good psychiatrist will know what tests are needed and helpful, no one else will. The doctor will also fight the insurance companies for you. Everything our doctor has recommended has been paid by the insurance company. Sometimes with a fight but always paid.

The other nice thing about going through a doctor is you will not fall prey to those that would sell you a line of bull program that will part you with a mess of cash but not improve your child's life.

J., most insurance companies will not cover treatments unless they're medically necessary. But getting your daughter assessed and treated for PICA, head banging, learning problems, language problems... that's all medically necessary. So you shouldn't have a problem with your insurance company. I wonder if perhaps your questions to the insurance company were vague enough that they gave you the stock answer of "we only cover what's medically necessary". Have you talked to your pediatrician about recommending a course of treatment for your daughter? Has seen been seen by Early Intervention? Either of those sources could help you get a plan together and ensure that insurance covers it. Good luck!

According to the insurance/medical feilds this is a mental disorder and depending on your mental health coverage it is not covered. My son has Adhd & Sensory Processing Disorder & Speech Delays, these are all denied as covered. Our check ups, we see the dr every 3months are put down as well visits and because we have so many free visits a year under this label we get away with it but we can not call them Adhd follow ups or anything like that. It sucks, it is not ok but until these are classified differently it will not change. It will take a serious movement by the medical feild for this to happen because if there are no doctors willing to fight the insurance companies you may as well just pound sand. I hope you are getting services with ECI or EI
http://www.developmentalweb.com/Washington_State_Early_In...

You have a battle ahead of you with the insurance company, and I hope you seek help with your child there is help out there.

Hi, autism diagnosis and treatment is not currently mandated in Washington, therefore your insurance carrier is not required to provide coverage. I did see that a bill was introduced earlier this year and if passed, coverage will be mandated. This doesn't help you now but at least there's hope for coverage in the future. Do you have ECI in your state that you can contact about services?

I don't envy your position. My youngest, now 13, has mild CP. At first our insurance provider wouldn't pay for his treatment either.
Keep searching for answers, keep fighting for your child. There has to be a way. Never give up and when you are frustrated come here. We know it isn't easy, we know you are doing your best. Keep going, no matter what happens you love your child and will do what it takes.

I live in Indiana, so our laws, etc. are different. But one thing I have learned is - a good pediatrican will find a way to call it anything but autism.... A lot of the therapies could be used for many medical reasons. Occupationa therapy, speech therapy, etc. Try to network with others in your area through an autism support group and find out how they have gotten their therapies covered. My insurance denied it under the mental health part, but paid it under the medical part. The doctor's office has to know how to code the claim. Also, if it is deemed educational, the schools may pay for a lot of the testing, etc. Even if your child is preschool-aged.

The major center for Autism/Asbergers on the west coast is the University of Oregon. Call them.

As for the insurance companies if there were a hell all the top execs would be in it. They may be in violation of the new law on the books concerning health care for children. Call your Congressman. And, if they are in violation. SUE,SUE,SUE.

I have knowledge in this area through my job...please message me and I can help.

M.

Medically necessary may come later once she is old enough for them to be more concerned about lack of speech (closer to 2).
In the meantime you can self-refer to Birth to 3..gov't program ran by counties. It should provide some help or at least guide you to other help. Birth to 3 is free to you.
Continue to advocate for your child. By th time she is older it will be so easy for you...now not so much.

I was in your shoes myself. My child lost his speech and was non-verbal at 17 months. Our insurance is Kaiser Permanente, they tell people only about services they cover, not what your child actually needs. We went to OHSU's Autism Clinic for evaluation. It's very expensive (up to $2,500) but very thorough and Kaiser, after denials, paid it, then took money back. We are still going through appeals for that. It was worth it. OHSU recommended 20-25 hours/week of therapy and it did wonders--our child speaks again and is in a mainstream preschool with typical peers. You need to act NOW, the younger your child is the better. Also, contact your legislators about Oregon bills SB 555/HB 2214--mandate for insurance to cover autism. This is legislation written by parents (an Oregon Senator is also a parent of an autistic child) and advocacy organizations to make insurance companies in Oregon pay for diagnosis and treatment of autism. 24 other states already have such mandates but in Oregon insurance industry (including Kaiser) has been fighting hard against this legislation and we need more support from parents, otherwise many kids will be left without treatments that can help greatly (47% of young kids may regain "typical" function and 40% make significant progress with intensive therapy like ABA). So, act now to help your child and other people in Oregon. The legislation applies not only to austim but also Asperger's, PDD-NOS, etc. Call your legislators today, we want this passed as soon as possible. The state of Arkansas passed this mandante in 2011 in 29 days! Oregon is so far behind and there are so many kids and adults that really need help. And I would greatly recommend OHSU.

It sounds like WA is way behind the times on this! I'm in the opposite situation, where our insurance company has great ASD coverage, but the local experts work for the state and won't take our private insurance (and we've been turned down for state aid several times).

In the meantime, read, read, read. My 12yo was dx'ed with Asperger's at 4, and he's come an incredibly long way, mostly with interventions we've used all on our own!