Re: Warning re: Aetna and ABA sessions

January 24, 2010

, we're a 10-people group, the mandate is good for plans of 50 or more

employees. I knew that going in and even sent them a copy of the mandate text

along with all docs reports, assessments, etc. Kept hearing from our " behavioral

care planner " that everything was fine, and that we didn't qualify per the

mandate for up to $36K for ST/OT/ PT, because those therapies weren't proved to

work as treatment for Autism... But ABA was toooootally different. I made

several calls to the claims dept because there was always something wrong with

the reimbursement but then the care managers always dismissed those mistakes as

that, they didn't know about ABA... BS, now I know better.

>

> Why don't you qualify??

>

> From: sList [mailto:sList ] On

> Behalf Of Gabi

> Sent: Saturday, January 23, 2010 6:20 PM

> To: sList

> Subject: Warning re: Aetna and ABA sessions

>

> Hello everyone, I know there were a couple of parents here who were trying

> to get Aetna to pay for their kids' ABA session so beware!

> We had our son's plan of treatment approved and over 60 sessions authorized

> by Aetna, in spite of us asking several times if they were sure we

> qualified. Yes, Yes, yes all the time. On Wednesday after calling to figure

> out why we were being denied reimbursement for some of the sessions, I was

> told that Aetna was denying all sessions because we didn't qualify. HUH?

> Yeap, they are also asking for the money back... So.... Has anyone being in

> a hole like this? Lol, I have to laugh, it's unbelievable! Any advice?

> Thanks in advance...

>

> Gabi

>

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