aetna Re: Insurance Discontinued for Speech Therapy

[Guest guest]

interesting that it appears AETNA is classifying autism as developmental delay. Sometimes they choose to classify it as a mental disorder.

the arguments that i have received from AETNA in the past were:

if a child has the ability to speak, the child is in a car accident and suffers brain damage, insurance will cover therapy to the end of time for the child to recover the speech-even if it never happens!

they do not cover therapy to gain a skill never had.

did your child ever speak? if so, do you have proof, ie: video tape, qualified witnesses. that be your only avenue.

i have never gotten aetna to agree to cover aba therapy: "it's experimental and there is no proof that it works." what about bcba degree? they don't recognize it.

it's a stretch but you might go after continuity of care with the therapy clinic - aetna covered the sessions in the past, there is proven progress, without it then there will be regression - which may be your course of action - now your child has lost a skill and needs to regain it.

aetna continues cover physical, occupational, and speech therapy for my son. he is classified as developmentally delayed. but - he also has brain anomolies. he is not regaining lost skills. he is gaining skills.

they contradict themselves all the time.

also, employer has a lot to say about what is covered and what is not covered. the more they cover, the more the insurance costs them as a company. typically when employer is confronted they claim they have to do what insurance tells them - i have found that's not always true as the employer dictates to insurance company what they want to cover.

Subject: Insurance Discontinued for Speech TherapyTo: Texas-Autism-Advocacy Date: Sunday, November 2, 2008, 9:20 AM

After a year of coverage, Aetna has stated that my son's speech therapy is not covered by insurance since it is due to developmental delay. When I asked why they had covered him for the prior year, they said that "it was a mistake". First they tried to state the "more than 25 sessions" was the reason but then came back to the "not covered at all" position.I'm getting ready for battle and want to know if anyone knows of anything I can cite based on their historical coverage or any other regulations/ litigation for Texas insurance companies? Are there different codes I can use or have it classified as ABA or something else in order to get coverage?Notes: My son attends one hour of private speech per week in addition to the 2 group 25 minute sessions he receives through the elementary school. He is 8 years old. He was diagnosed 4 years ago with autism by Texas Children's Hospital, and as

PDD-NOS by a private psychologist. Aetna covered his speech from July 2007 through June 2008 and then started denying payment sporadically after that.Thanks in advance for any help you can provide.-Sandy H.Max's Mom