Appeal against Insurance for ABA Therapy

[Guest guest]

Our lawyer has filed an appeal against our insurance

company for denying our claim for ABA treatment for our

severely autistic son (3.5), . We have " Letters

of Medical Necessity " for intensive, behavioral therapy

for multiple doctors. The insurance company classified

his claim as medical and took 6 months to deny the claim.

They denied ABA therapy because: " the service or supply

must be accepted under recognized professional standards

as appropriate and effective for the diagnosis... "

and " it should not be experimental or still under

clinical investigation " .

I could have accepted a denial for any other reason than

above - but to deny ABA treatment as experimental; what

is the " recognized professional standards " and what

treatments are considered non-experimental for children

with autism?

Has anyone fought this battle with their insurance

company before? I have provided the reports from Maine,

New York to our attorney, but references other

information from " professional standards " organizations

as to the efficacy of ABA/VB in the treatment for young

autistic child would be wonderful!!

Thanks,

Adel

[Guest guest]

I would write a letter to the insurance company and suggest that they

review Chapter 3 of the Surgeon General's report. In particular they

should look at the section on autism. Remind them to deny a child a

medically needed service, endorsed by the surgeon general has the

appearence of discrimination based on a child's disability. This is a

violation of federal policy.

Joe