Saturday, February 28, 2015

Our insurance company has authorized ABA therapy

We got a nice surprise in the mail today. Our son's individual Blue Cross Blue Shield of Michigan insurance policy has authorized ABA treatment for Andy. The letter they sent also states that the notification we received does not guarantee payment for services. However, they are authorized. It is a little confusing.

They are allowing 600 units of Therapeutic Behavioral Services, with a unit being 15 minutes. It looks like the authorization is only good through March 31st, which doesn't give him much time to get started back into the program. I don't even know if they have trained staff for him yet. Hopefully, the center will be in touch with us soon, and can get these dates extended. They are also authorizing home care training, and training to the home care client, which would be me.

The authorization was done by an outside company called Magellan Behavioral of Michigan. The procedure codes authorized were: H0031, H2019, S5108, D5111, and H0032. These codes were denied by my son's previous Blue Cross policy, because we supposedly didn't have autism coverage on that policy. However, when I called the previous insurance company's policy reps and gave them the above codes, I was told they'd be covered at 90 percent. Then they rejected all the claims.

His new individual policy has Autism coverage, and falls under the state mandate on Autism coverage. Apparently, 80 percent of employer given insurance policies do not fall under the Autism mandate. So, we sought out an individual plan, and asked specifically about the Autism coverage before signing Andy up for it. What a hurdle this has been.

1 comment:

  1. My youngest son was born with an encephalocele and hydrocephaly. He's had two surgeries, and has a vp shunt. A lot of the things you're dealing with in your son, we see in kids with encephalocele. My youngest was just diagnosed with Autism as well (and he's not my first spectrum kid, he's my 4th, out of 7 kids). I'm looking into ABA and other therapies now, if only to help with his behaviors. I find the headbanging particularly troubling.

    I can't believe how overwhelming I'm finding it, considering it's not my first rodeo.

    I know I will be checking back here to see how your kiddo is doing. You are most definitely not alone!