Neurodevelopmental and Behavioral therapies’ exclusions in the Self-Funded plans

WAAA-LOGOIf your child or children are:

  • insured through a large employer that is self-insured (i.e. coverage through private (for-profit or nonprofit) employer including cities or counties), and
  • they have been denied medically necessary neurodevelopmental therapies (i.e. Speech Therapy, Occupational Therapy) or behavioral therapy (i.e. Applied Behavior Analysis)

WAAA would like to hear from you at your earliest convenience, please call 425.894.7231 with the following information:

  • your employer’s name
  • the type of treatment that is prescribed, but denied or unreasonably capped
  • name of the insurance company that manages your benefits

Please forward this note to any parent whose children may be in a similar situation.

Thank you for your consideration.

 

Mira Posner
Attorney
Washington Autism Alliance & Advocacy
16225 NE 87th St. Ste. A-9
Redmond, WA 98052
Phone: 425-894-7231
Fax: 206-299-3661

5 thoughts on “Neurodevelopmental and Behavioral therapies’ exclusions in the Self-Funded plans

  1. Suzanne – Please call our office 425.894.7231, Melanie is looking forward to helping you with your benefits through Valley Medical.

  2. Carina – We would be happy to help. When you have some time, call Melanie @ our office 425.894.7231. We need a little information about how your daughter is insured. I will make an introduction to her via email. Thank you!

  3. Suzanne and Carina,
    I would like to let you know that because the ACA and the Medicaid expansion is Washington State that you may not have to have your children on your employer’s group plan. The only person required to get insurance through the group plan is the employee. Depending on your income level your kids could qualify for CHIP. It used to be for a family that had a lower income but that has changed in a big way in 2014. Here is a link to the income guidelines for 2014 http://www.benefits.gov/benefits/benefit-details/1615 A family of four can make $71,550 a year and your kids STILL qualify. I know you might think I don’t want to have my child on CHIP or Medicaid because of the stigma that goes along with it. I am telling you I have never had the type of relief that I have now. My son has had no problems getting the treatment he needs. He is currently going through the “process” of diagnosing autism. In the mean time he has a diagnosis of developmental delay and requires ST/OT and many, many hospital based clinic appointments. If he does get an ASD diagnosis HCA will pay for his therapies without a limit on ST/OT/PT and ABA (however there is a year wait) He is 4. I have had no problems getting his therapies and have not had to meet a deductible or even had copays. This has been an enormous relief for my family because I can not work due to my son’s condition and we have two other children.
    I have been in the healthcare field for many years and have a thorough understanding of insurance policies and billing and coding. Please email me if you need help. I want your kids to get the same treatment that my son Harry has. My email is jedwards7@live.com

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