Friday, September 12, 2014

Blue Cross Blue Shield is rejecting my son's Autism claims for ABA therapy

This is so awesome! Blue Cross Blue Shield of Michigan has decided to reject all of my son's Applied Behavioral Analysis claims for Autism therapy. I spoke with one of their representatives before he got any therapy done. I noted the time, date and duration of the call. I gave the rep each CPT code that the Autism Center would be using. I was told each would be covered at 90 percent, and using the Autism diagnosis code of 299.00 was fine.

When the center called BCBS of MI they asked if an authorization was required before going ahead with therapy. They were told "no auth is required, just start billing". So, based on my call to them, and their call, we started therapy. The center didn't bill until about a month out. I checked to see if there were any pending claims, every week. I finally could see some, when he was already at week 6.

How much does ABA therapy cost? This is what I kept asking the center. They would tell me, it's different for everyone, and did not want to give me a dollar amount. Well, ABA therapy costs around $1,000-$1800 a week. Yes, a week. They billed per fifteen minute units, and it is pricey. My son was there for 5 hours a day, 5 days a week.

It did benefit him, as he is pointing to what he wants now. I offer him two choices of what to eat, and he points to what he wants for each bite. ABA therapy has helped him to communicate with me. He was worked with one-on-one for the whole day, and now he is starting to show signs that he did learn some communication skills from them.

It is a bummer that Blue Cross Blue Shield is doing this to us. We have a PPO plan. It is super expensive too. They usually cover everything. A rep called me and told me, "although the president passed something to make insurance companies pay for Autism claims, we don't fall under the state mandate". So, my son's claims have been rightfully rejected.

It is coming down to them finding the recording of me talking to the representative on the phone. They are supposed to listen to it, and see what she told me. Hopefully, they will realize they should pay. We wouldn't have gone through with the therapy had we known they wouldn't pay.

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