[SPAM] Re: Insurance

[Guest guest]

You are absolutely right about the employer choosing. That is consistently

the hardest thing for parents to understand—they could both be using the

same insurance company and yet have very different services coverages based

on the contract that the employer chooses to carry. I’m really glad to hear

that about that your company has purchased a good policy through Aetna. Do

you know if it’s part of the policy or is it a rider? I’ve been hearing

that some companies purchase riders that employees can opt into.

I’ve been reading the autism insurance list serve for awhile, and Aetna

usually takes a beating on there so thanks for letting me know about that.

Below is something that I copied from a list of an Aetna policy—can’t

remember what state this is from though:

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

++++++++++

Aetna considers the following procedures and services experimental and

investigational because the peer-reviewed medical literature does not

support the use of these procedures and services in the assessment and

treatment of autism and other pervasive developmental disorders:

Assessment:

1. Allergy testing (especially food allergy for gluten, casein,

candida, and other molds)

2. Erythrocyte glutathione peroxidase studies

3. Event-related brain potentials

4. Nutritional testing

5. Hair analysis for trace elements (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/300_399/0300.html " \nCPB 300 - Hair

Analysis )

6. Intestinal permeability studies

7. Magnetoencephalography/magnetic source imaging (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/200_299/0279.html " \nCPB 279 -

Magnetic Source Imaging/Magnetoencephalography )

8. Neuroimaging studies such as CT, MRI, MRS (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/200_299/0202.html " \nCPB 202 -

Magnetic Resonance Spectroscopy [MRS]), PET (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/1_99/0071.html " \nCPB 071 - Positron

Emission Tomography), SPECT (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/600_699/,../300_399/0376.html " \nCPB

376 - Single Photon Emission Computed Tomography [sPECT] ), and fMRI

9. Provocative chelation tests for mercury

10. Stool analysis

11. Tests for celiac antibodies

12. Tests for immunologic or neurochemical abnormalities

13. Tests for micronutrients such as vitamin levels

14. Tests for mitochondrial disorders including lactate and pyruvate

15. Tests for thyroid function

16. Tests for urinary peptides.

Treatment:

17. Auditory integration training (auditory integration therapy) (see

HYPERLINK " http://www.aetna.com/cpb/medical/data/200_299/0256.html " \nCPB

256 - Sensory and Auditory Integration Therapy )

18. Chelation Therapy (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/200_299/0234.html " \nCPB 234 -

Chelation Therapy )

19. Cognitive rehabilitation (see HYPERLINK

" http://www.aetna.com/cpb/medical/data/200_299/0214.html " \nCPB 214 -

Cognitive Rehabilitation )

20. Elimination diets (e.g., gluten and milk elimination)

21. Facilitated communication

22. Holding therapy

23. Immune globulin infusion

24. Lovaas therapy / applied behavior analysis / discrete trial training

/ intensive intervention programs

25. Music therapy and rhythmic entrainment interventions

26. Nutritional supplements (e.g., megavitamins, high-dose pyridoxine

and magnesium, dimethylglycine)

27. Secretin infusion

The significant problems we have cannot be solved

at the same level of thinking with which we created them.

Albert Einstein

From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of r_woman2

Sent: Wednesday, May 21, 2008 11:10 PM

To: Texas-Autism-Advocacy

Subject: [sPAM] Re: Insurance

>

> Aetna is TOUGH. I heard that they actually developed an internal policy

> statement that autism isn't a disorder at all so they don't have to

cover

> it!

, it is your employer that decides what coverage to purchase.

I have Aetna, have had for some years, and they are covering

everything autism. I have unlimited speech therapy with no

developmental exclusion, which was my employers decision, not the

insurance company's.

Ruth

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7:06 AM

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7:06 AM

[Guest guest]

>

> I'm really glad to hear

> that about that your company has purchased a good policy through

Aetna.

Yes, me too! Especially since I live in a state where SPED services

are not exactly top of the line. Sorry if that offends anybody. I

don't know what I'd do without it, and honestly I think about how it

must be for others who are not so fortunate every day.

Do

> you know if it's part of the policy or is it a rider?

They told me at our OT/speech therapy center that employers have to

sign a developmental exclusion for speech which is a separate piece of

paper, so it is something consciously done. They also told me they

see everything. Some policies cover evaluations only, some cover

therapy only, some cover both and some cover neither!

> Below is something that I copied from a list of an Aetna policy—can't

> remember what state this is from though:

This may explain why nobody has suggested my son get an MRI. I've

actually been wondering about that, since it seems it might be helpful

to physically see where the brain damage/dysfunction is at exactly and

how bad it is.

I know you can get around some of this stuff with a little cleverness

though. For example, the last clinical psych we saw commented that

she had to be careful to code for anxiety because psychotherapy is not

a proven treatment for ASD and insurance wouldn't cover it coded that

way. And for OT they mentioned they had to make sure they code it

developmental coordination disorder as a multiple dx, because AS by

itself won't work. And I imagine if my son had a seizure we could get

our MRI and also discuss ASD damage/dysfunction.

Ruth