Frequently we are asked: Why are MAPS ( Medical Academy of Pediatric Special Needs) doctors and other autism treating physicians SO EXPENSIVE? MAPS is the Medical Academy of Pediatrics Special Needs. MAPS Doctors specialize in the medical issues commonly found in individuals with autism, using a Functional Medicine approach. A group similar to MAPS was […]
Tag: insurance
Who Pays for What?! – A Guide to Services, Providers and Payors
Using this handy guide you will learn what services and therapies there are, who provides them, where they are provided and who is supposed to be paying for them BEFORE You start paying out of pocket. The “Who Pays for What” document covers: Service Name Service Description Who Delivers Service Who Funds Service Links […]
Autism on a Budget Series
By Holly Bortfeld I am a single mom of two adults on the spectrum so I know all about money concerns. Raising a child, or two, with ASD will break the bank! I have also been doing parent support for over 10 years and have been asked countless times, “How am I supposed to be […]
Medical Treatment on a Budget
By Holly Bortfeld A lot of people ask, “Why are medical treatments so expensive?” We are at an exciting time in medicine for autism as we are learning more every day about this disorder and its co-occuring conditions. Sadly, science is much slower than we would like and insurance coverage is even slower. Having no medical […]
Insurance Definitions
ABC (Alternative Billing Codes) Based on Complimentary and Alternative Medicine maintained by Alternative Link. Congenital A disease or disorder that is a result of genetic abnormalities, the intrauterine (uterus) environment, errors of morphogenesis, a chromosomal abnormality, or a complex mix and unknown factors. Some factors can include heredity, environmental, or behavioral. Congenital disorders vary widely […]
Autism Insurance Resources
California Autism Insurance Illinois Autism Facts Oregon Autism Insurance Pennsylvania Autism Insurance Information Department of Insurance and State Laws How to Fight a Health Insurance Denial, by Brie Cadman 49 States OTHER THAN CA: Autism Insurance Information Group List For parents and practitioners to learn about coding and insurance problems. CA ONLY: Autism Insurance Information […]
State Medicaid
This is a very important piece of the puzzle. Medicaid can pick up what your insurance company doesn’t pay, including co-pays. Also, if your HMO has strict limits to the number of visits, Medicaid would kick in and pay after those visits have been exhausted, if you are using a Medicaid provider. Most states have Medicaid (income-dependant) […]
Autism Insurance Legislation
There are a number of efforts happening throughout the country to get autism treatments, or at least ABA therapy, covered in states. Parents and advocates are working together to get coverage. You can help too. Keep reading. States that have insurance legislation in place (some better than others): Arizona: Effective June 30, 2009. Covers therapy costing as […]
Health Savings Accounts
A Health Savings Account (HSA) is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. You must […]
What is ERISA?
ERISA is the abbreviation for the Employee Retirement Income Security Act. Let’s say you live in a state with a parity law – like California’s AB88. Wahoo! Right? Not so fast. Here is the glitch – The law only pertains to SOME insurance companies. The insurance plans that are self-funded, are exempt! Ouch. How do you know if your […]
Appealing Insurance Claim Denials
How Did We Get Here? Example 1 Your child has autism. Your child also gets sick, a lot. You take him to the doctor, again, to see what they can do to get him healthier. The doctor orders blood work that shows your child has a very weak immune system and multiple food allergies. The doctor refers […]
Supplements & Prescriptions
Buying Supplements and Non-Insurance Covered Meds Over the years, I have seen many people be successful 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 […]
How to Start Working with Your Insurance Company
What NOT to do is just as important, maybe more, than what to do. “Autism is UNTREATABLE” Many parents have told us that their insurance companies view autism as untreatable. They consider autism as untreatable so they don’t have to cover anything related to it. Almost any treatment billed to the insurance company with a diagnosis […]
Insurance for Beginners
For those totally new to health insurance, here is a short primer to get you started. Before you begin, you need to know who is responsible to pay for what services (Who Pays For What – PDF). CPT (Code of Procedural Terminology) CPT is the code used to describe what treatment is being provided (i.e., […]
Insurance Pays For What?
For a more detailed understanding of who is responsible for covering which specific expenses please see our Who Pays For What information. The “Who Pays for What” document covers: Service Name Service Description Who Delivers Service Who Funds Service Links It also explains Coverage Types (SSI, Insurance, Medicaid, etc) as well as definitions of therapies […]
Billing Codes That Work
Disclaimer: The codes included are to be used as a GUIDELINE and there is no guarantee of coverage but we hope this will help you get the help your child needs. This list is dynamic and will change as parents give us feedback on what worked and didn’t work for them. Please check back occasionally […]
Lab Tests and Codes (CPT)
Below is what a typical Autism-specialist doctor PAYS for a test through typical autism-specialty labs as of June 2008. Autism-specialist doctors have NEGOTIATED these prices with the labs.Your standard pediatrician will likely not have these lower negotiated prices with the specialty labs but will have them with Labcorp and Quest, where most Autism-specialist doctors will […]
Common Co-Morbid Disorder ICD9 Codes
The following is a list of commonly used ICD9 (diagnosis codes) for the co-morbid disorders ASD children may have. There is also a list of commonly used tests with their ICD9 codes. ICD9 code ICD9 wording 034.0 Streptococcal sore throat 054.9 Herpes simplex without mention of complication 088.81 Lyme disease 112.5 Systemic candidiasis 112.82 Candidal […]
Sample Insurance Letter (California)
VIA CERTIFIED MAIL INSERT CLAIM HANDLER’S NAME CLAIM HANDLER’S TITLE CLAIM HANDLER’S CITY STATE ZIP RE: ENROLLEE’S NAME ENROLLEE’S DATE OF BIRTH ENROLLEE’S SOCIAL SECURITY NUMBER HEALTH PLAN PURCHASER’S NAME HEALTH PLAN IDENTIFICATION NUMBER CLAIM NUMBER SUBJECT: Payment Authorization for Enrollee’s autism Dear: Please deem this letter to be a formal, urgent and continuing request […]
California Law On Health Care Reimbursement
Christopher E. Angelo, Attorney at Law, has been kind enough to provide us with his updated summary of the law of private insurer special needs state mandates. He also includes an attachment of the Illinois Wheeler decision that also provides assistance to parents. In addition, he has provided a form claim letter. Christopher E. Angelo […]
