Comments on: When Insurance Coverage Doesn’t “Cover” What You Need

By: Kristina Chew, PhD

Kristina Chew, PhD — Fri, 30 Nov 2007 05:21:12 +0000

Another decision regarding ABA and insurance: An arbiter hasordered Anthem Blue Cross/Blue Shield to cover the costs of ABA therapy for the Tapper family of Boulder, Colorado.

By: Kristina Chew, PhD

Kristina Chew, PhD — Sun, 16 Sep 2007 00:57:04 +0000

deb, thank you so much for noting all this—it’s very helpful and I am curious about what might follow after the ruling for the Michelettis.

By: deb

deb — Sat, 15 Sep 2007 13:57:35 +0000

The Micheletti’s are very interesting people; my path has crossed theirs and I’ve had a chance to talk to them both. What started as a battle to cover Jake has turned into a crusade to help every family dealing with autism get these therapies covered by insurance.

They have helped many people get insurance coverage with the rulings of the lower courts. This went to the supreme court because lower courts kept ruling in their favor but the SHBC refused to comply. Apparently the Michelettis have advised many families to attach their court rulings to their insurance claims to get therapies covered and those families have been sucessful. The “habilitative” vs “rehabilitative” point is moot in New Jersey. Any insurer cannot say that autism is not covered because it is not a “rehabilitative” condition. The court has stated that all children have the potential to develop typically with intervention.

Further, this is precendent setting because NJ courts are the first in the nation to rule ABA and VBA as “nonexperimental.” This sets the stage for other states to use this ruling to force insurers to cover these types of therapies.

This was a big win this week.

By: Kristina Chew, PhD

Kristina Chew, PhD — Sat, 15 Sep 2007 03:28:00 +0000

livsparents, yes, what if only therapies “proven to work” can be covered: but then comes the problem of what it means for something to “work.”

bink, that’s my ever-present question: how about we try to help autistic persons now—-for my son, it is people, people, people. therapists and teachers who have the right training and supports who can help him achieve his fullest potential.

By: resilientmom

resilientmom — Sat, 15 Sep 2007 00:35:00 +0000

How about embracing the autistic individuals that are already here! What about jobs and housing and springboard programs to foster independence? That is a government responsiblity.
The insurance industry is complicated and should support grassroots therapies, so ultimately goals are reached. This does not mean that autistic children are totally autonomous adults. Autism is NOT A SCAM! Would any one of us choose this requisite for life?

By: livsparents

livsparents — Fri, 14 Sep 2007 23:08:57 +0000

Better yet, how ’bout research into therapies to prove that they work. So that the insurance companies can’t slip through the loophole of ‘experimental treatment’?

By: Bink

Bink — Fri, 14 Sep 2007 22:50:22 +0000

p.s. this is why any time I read of huge amounts of $$$ going for “autism research” I want to ask: where is the money for autistic PEOPLE? The ones who are already here?

By: Bink

Bink — Fri, 14 Sep 2007 22:46:48 +0000

I have thought a lot about this issue, too. Most people seem to assume that our medical insurance has paid for all of the various therapies my child has had. It didn’t, and the school offered limited services. I am indescribably thankful that we happened to be in the position to sell a house in pricey area of the US and move to a less-pricey one just when our child had these needs. We took our windfall and spent it on her. I do not sit around and think “crud, think of all that money that could be in my retirement account” or “I wish I could drive a new car and have decent clothes” because I realize we were far luckier than most people in our position. I don’t know what the answer is, really, for society and for the individuals. But it’s hard.

By: Kristina Chew, PhD

Kristina Chew, PhD — Fri, 14 Sep 2007 20:14:01 +0000

Leanne, I’ve been thinking the same and I really don’t know what the right answer is. But it is true, our kids need a lot.

By: mommy~dearest

mommy~dearest — Fri, 14 Sep 2007 18:52:37 +0000

Kristina- yes, that’s the correct foundation.