Try, Before You Apply
January 27, 2011
These are Top-Ten Services requested from the TACA Scholarship Program and the alternate funding sources to pay for them.
Most Medical Academy of Pediatric Special Needs (MAPS) doctors order test panels that are easy for them to read, all the information in one nice, neat bundle. The problem is that insurance doesn’t cover a lot of the specialty lab companies so parents have to either pay out of pocket to make it easier on the doctor or use insurance-covered labs to measure the same markers on the specialty lab panel.
- OAT Test
- With the exception of gut pathogen metabolites, a regular quantitative organic acid test will tell about most of the other markers on the OAT.
- For the gut pathogen metabolites, a stool culture, O&P x3, giardia, cryptosporidium will give the bacteria and parasite parts.
- The only bad part is that no commercial test measures beneficial flora levels. One could just use a broad spectrum probiotic, though it is better to focus more on which type of probiotic is low if there is an imbalance. The CDSA from Genova Diagnostics does all this and some insurance companies will cover it. Call your insurance company to see if they will cover the test. The Genova site offers CPT codes to use when calling about coverage. Also, visit our Lab Tests and Codes (CPT) page here.
This can be achieved with 2 pieces – a standard-lab OAT and stool testing.
- Heavy Metals Tests
- Urinary Porphryns testing is offered by Labcorp and Doctors Data (both a random and 24-hour).
- Quest Diagnostics and Labcorp offers several heavy metal panel choices, blood and urine. Quest and Labcorp both are covered by insurance. Doctors Data is covered by some insurance companies. Call yours to find out.
- RBC (Red blood cell)This is a standard test that insurance covers.
- Amino acid panelThis is a standard test that insurance covers.
- IgG Food Allergy testThis is a standard test that insurance covers.
Roughly 80% of families get these covered by insurance. First, check your pharmacy policy and find out which compounding pharmacies are on the plan (there is usually at least one in network). If they don’t cover the compounder that your doctor recommended, you can use one they do cover or find out what your out-of-network benefits are, if any.
If your policy won’t cover the shots for MB12 deficiency alone (266.2 Vitamin Deficiency: B12), you can test for methyl hydrofolate reductase enzyme, if positive, the insurance should then pay.
While very few MAPS doctors take insurance, you can still submit the office visit bill for reimbursement. Out-of-Network provider reimbursement rates are lower, but something is better than nothing.
Insurance companies provide out-of-network provider reimbursement forms.If you didn’t receive any with your insurance booklets when you were hired, or have lost them, you can:
- Ask the company’s human resources to give you more
- Go to the health insurance website to print one out
- Call the insurance company and have them mail you some
Complete the insurance company’s reimbursement form(s) and attach the superbill or invoice. It’s also a very good idea to make sure your superbill shows that you already paid the provider (shows a zero balance). Then send a cover letter saying you already paid for the service and reimbursement should be made out to you and sent to you directly. Attach any pre-authorizations or prescriptions for the service and a letter of medical necessity if you have them. Find more information on billing coding here.
Over the years, I have seen many people be successful at getting their insurance companies to cover compounded vitamins. But there are tricks to being successful.
Make sure your insurance plan doesn’t exclude vitamins and supplements before you start.
If your child has a diagnosis of a disorder/disease that is shown to be treated with a particular vitamin (that has an NDC#) and that vitamin is in your mixture, you should be able to get it covered. (NDC: National Drug Code)
If your child has an allergy to an ingredient in the standard OTC vitamin mixture, you might be able to get it covered.
Tip! Start with trial-sized bottles of vitamins first to see if your child will tolerate them before you spend a lot of money.
Remember, save your receipts, as supplements may be written off on your taxes. Please see Tax Strategies for Parents of Special Needs Children.
Hyperbaric Oxygen Treatment (HBOT)
Since very few insurance companies cover HBOT for the disorders associated with autism, a lot of HBOT providers offer bulk pricing. Instead of paying a per-dive price, if you buy a package of many dives (you can usually split the package with other families too) the per-dive price is much less. Another option is to rent or buy a portable chamber and share it between several families.
Autism Relief Foundation also offers grants.
ABA, OT, Speech or Other Ongoing Therapies
TACA’s scholarship program does not cover any ongoing therapies. Please read Insurance Coverage for Medical & Traditional Treatments and Who Pays for What (PDF) to see how to get these covered.