Sigh. Mommy is annoyed, really, really annoyed.
Last weekend when we were at the conference, I visited a booth for a private ABA provider- their flyer said that they accepted Cigna. We have Cigna! Goody! I was talking "insurance talk" with the representative and she said that although they have a contract with Cigna, they have never had a client successfully get services with this insurance. Well, I am an insurance case manager right? So I thought I would at least explore.
The first thing I checked was the state law. Discouraging fact #1- Maryland has no mandate for insurance companies to provide autistic children with ABA (applied behavioral analysis therapy). It has gone before the legislative session multiple times and never passed. Let me explain why this is a travesty. The medical community at large still does not acknowledge autism as a medical problem. It is considered strictly behavioral. Therefore, the ONLY therapy that said community recognizes as legitimate for autism treatment is ABA. This is why OT has to be billed as developmental delay and not autism. OT would not be covered for autism. And speech has to be billed as speech delay, not autism. None of these services are covered for autism. A neurology consult similarly would be billed as some type of neurological deficit, but not autism. The insurance would not pay if it was billed as autism. So to discover that the one widely accepted therapy for autism is not mandated in our state made me, well, really really pissed.
OK, well we have private insurance, right? It doesn't have to be mandated for them to cover it. So I called the ABA company and asked for the CPT codes they use for ABA, then called our insurance company. No one knew what ABA was- awesome. I realized that this was because I hadn't selected behavioral health. Mainly because I KNOW that autism is not just a behavioral problem- it's roots are deeply based in medical issues. Oh well, so I called back and asked for behavioral. When I asked about ABA, the representative asked, are you worried that your child might have autism? I kind of laughed and said no, my child does have autism. She gasped and said, don't you have an autism case manager? Ha. She further stated that I NEED a case manager for my son because there are "additional benefits" for children with autism. Well this is news to me, because when I do a provider search on the behavioral website and enter "autism" as the speciality, big blinking letters pop up and warn me that "this service may not be covered for the diagnosis of autism." Which, frankly, is why the insurance company has not been aware of my kids' autism. We don't need any added challenges. Anyway, the rep said she was going to assign us to a case manager and "expedite" it. I guess that's what you get when they know you're a case manager too.
Last weekend when we were at the conference, I visited a booth for a private ABA provider- their flyer said that they accepted Cigna. We have Cigna! Goody! I was talking "insurance talk" with the representative and she said that although they have a contract with Cigna, they have never had a client successfully get services with this insurance. Well, I am an insurance case manager right? So I thought I would at least explore.
The first thing I checked was the state law. Discouraging fact #1- Maryland has no mandate for insurance companies to provide autistic children with ABA (applied behavioral analysis therapy). It has gone before the legislative session multiple times and never passed. Let me explain why this is a travesty. The medical community at large still does not acknowledge autism as a medical problem. It is considered strictly behavioral. Therefore, the ONLY therapy that said community recognizes as legitimate for autism treatment is ABA. This is why OT has to be billed as developmental delay and not autism. OT would not be covered for autism. And speech has to be billed as speech delay, not autism. None of these services are covered for autism. A neurology consult similarly would be billed as some type of neurological deficit, but not autism. The insurance would not pay if it was billed as autism. So to discover that the one widely accepted therapy for autism is not mandated in our state made me, well, really really pissed.
OK, well we have private insurance, right? It doesn't have to be mandated for them to cover it. So I called the ABA company and asked for the CPT codes they use for ABA, then called our insurance company. No one knew what ABA was- awesome. I realized that this was because I hadn't selected behavioral health. Mainly because I KNOW that autism is not just a behavioral problem- it's roots are deeply based in medical issues. Oh well, so I called back and asked for behavioral. When I asked about ABA, the representative asked, are you worried that your child might have autism? I kind of laughed and said no, my child does have autism. She gasped and said, don't you have an autism case manager? Ha. She further stated that I NEED a case manager for my son because there are "additional benefits" for children with autism. Well this is news to me, because when I do a provider search on the behavioral website and enter "autism" as the speciality, big blinking letters pop up and warn me that "this service may not be covered for the diagnosis of autism." Which, frankly, is why the insurance company has not been aware of my kids' autism. We don't need any added challenges. Anyway, the rep said she was going to assign us to a case manager and "expedite" it. I guess that's what you get when they know you're a case manager too.
We are in a similar situation with my son diagnosed for autism and same Holly from Cigna gave similar answer. wondering if u were able to get coverage.
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