We talk About Autism.

Appealing health insurance denials.

Your trusted team of doctors and therapists build goals and a therapy plan, but insurance denies and just like that, your child’s therapy is cancelled. 

The momentum of progress is stopped in its tracks and your child’s routine hits a major speedbump as their balance, their routine is completely thrown off. 

All of this because a billing code did not match what the insurance company uses or allows. Or because an important document or recommendation letter is misplaced or falls off the pile of faxes into purgatory. 

I believe insurance paperwork and process should not overrule recommendations from a doctor or Board Certified Behavioral Analyst’s education and years of experience working with autistic children, years working specifically with our child.

Don’t give up when the denial letter arrives. Insurance companies want you to give up, to accept THEIR self-serving plan. 

Read the justification of denial, the reasons the therapy or care was denied.

What is incorrect in the letter? Which doctor or provider could write a quick letter on very professional letterhead or send over a clear document to refute incorrect information? 

Now is the time to shutdown being shy and any negative self talk. If your team thinks the insurance denial is incorrect, appeal it. 

How do I appeal? Read the last section of the denial letter to see where to send information for an appeal. Then get your documents in order, write a letter requesting an appeal and consideration of your documents, and fax it all in. 

You are your child’s champion, you are the expert. Your team says their plan will help your child so you make the calls and send emails to get documentation where it needs to be quickly.

We fought three denials this May and June and won. Our insurance denied Jeanne’s full therapy plan and offered light services for this summer, her last summer with Caravel Autism Health.

Here’s the horrific part, our health insurance company:

• stated Jeanne’s name but then used all of our youngest daughter’s information in the letter of denial.
• used our three year old daughter’s goals and information.
• addressed the denial letter to a doctor Jeanne hadn’t had for two-years. 
• stated they did not have documentation for why Jeanne moved providers and wrapped it all up with a stamp of denial.

I was beyond livid. I spent hours for four weeks on the phone, gathering documents, and keeping communication flowing between our care team and the insurance company. We re-sent handfuls of documents that were “lost enroute.” 

What a waste of our daughter’s last months with her treatment plan. What an abuse of Jeanne’s progress and our team’s expertise and work with Jeanne. 

What a poor example of a crucial service we pay for. A service we count on to provide services to support our children’s lives.

Endless clerical and common sense errors of insurance staff translated to four weeks of missed therapy for my child.

Incorrect years dated on letters. Negligent training of claim and customer service representatives. Arrogant smart device app technicians with mis-dating all dates of service for the entire family, filing claims under incorrect family members, providing different deductibles for individual family members. The list goes on and on.

So we fought and we won.