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Thanks
for sharing that very important information, Brooke! Also thanks again for
sending out Valentines to our legislators! If anyone else out there “listening”
to this would like to send some, I still have a few left. I don’t think
it matters that they will be going out after Valentine’s Day, just
important that they go out sometime. I would especially like to see more go to
Dick Lugar, as he is often prone to vote on the wrong side of these issues for
us.
By not allowing for
treatment at an early age they will see more of these individuals needing far
more supports as adults. Meanwhile we parents are forced to pay for more than
we can afford out of pocket. That’s why we still haven’t gotten to
YAY! for
our “ICE DAY” today...sorry if you had to drive on it. This stay-at-home
Mom got to stay at home and sleep in. I would have liked some snow to play in
though.
Unfortunately this cold
weather has driven me to eat a lot in my effort to stay warm, I guess that’s
why...anyway cookie weather is not being
kind to me! Those darn
Blessings! ~Ronda
The
Indiana Insurance Mandate for Autism has been a big discussion on another
listserv that I belong to. Many Anthem members are upset about the
recently imposed limits placed on therapy visits.
For
example, if therapy visits for a medical issue (as in physical injury/illness)
are limited to 25 visits, then it is allowable for the insurance company to
limit visits for a child with an ASD to the same amount. We received our
limits on Sam late last year. We are allowed 25 visits.
There
is currently no limit on therapies dealing with behaviors (presumably because
there is no medical/physical alternative?
Also,
Brad and I received a nice letter back from one of our state senators in
regards to the Valentine's cards we sent out. I realize how these things
work, as I've sent things in the past, but I thought it was impressive that a
response was sent out so quickly! Just this insurance issue alone was
re-interpreted by the current administration.
Brooke
Autism
Insurance Mandate - response from IRCA
Here is the response
I got from IRCA regarding the autism mandate
and limits on yearly visits:
"The law did not change, the way the IDOI interpreted the
law changed in 2003 when the personnel (Commissioner
and Deputy
Commissioners for Health Care) changed with the new
administration.
Per Bulletin 136, which had been widely distributed by the
autism
community
leaders, insurers may place visit limitations on OT,
Speech and
PT as long
as the same limits are imposed upon physical
illnesses. This was
not the
intent when the law was written, and it was not enforced this way
prior to
Bulletin 136, but that is the current interpretation. Anthem, I
guess, is
just catching up to that.
If the insurer allows for extensions beyond the visit limits for
physical
illnesses based upon medical necessity, they must also do so for
autism. I
strongly encourage any family that is under limitations to
document ANY
regression and apply for an extension of benefits beyond the
limits of the
plan based upon medical necessity."
SO, if you can document regression, I would assume through
standard testing, then you can go back to your insurance company
and ask for more visits. I don't know how difficult it will be
but I am sure going to try!
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