Guest guest Posted April 3, 2001 Report Share Posted April 3, 2001 , I don't know if this will be helpful but I would check whether your clinic is part of an HMO. Sometimes, individual physicians are not bound by the same rules as a large HMO. For example, with our son we were originally seeing a family physician in what I thought was a small group practice. He " pretended " to advocate for us by submitting the lab request and then we were told only certain tests would be covered. (very few as it turned out). I did some digging and bugged a LOT of people and discovered that the group practice had a contract with our health plan and it was NOT the insurance company (Pacificare) that denied the claim, it was the management of the HMO that we belonged to. We switched to a pediatric group (and you can be darn sure I checked this out before joining this group) and found a very supportive pediatrician. He ordered ALL the tests using the codes suggested by Dr. Goldberg and we didn't pay a dime (except for the tests done through IDL and Meridian Valley which were not covered). Insurance today is very complex and you have to really do a lot of digging. Hope this helps. If you'd like more info, feel free to e-mail me privately. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 - We have our pediatrician write the referral for the tests so that they are covered by our PPO insurance (BC/BS). On Mon, 02 Apr 2001 14:59:21 -0000 " lj smith " <yyzbytor@...> writes: >Hello, >I have been a member for a little while now....sorry I never posted >anything. >THe reson I am writing now is to find out if you all have insurance >issues...when tring to get most of these test covered. I want to >continue on with all of this....but the cost (out of pocket) is >killing me. I tried to file insurance on some of the testing ...it >all came back denied... What are all of you doing to cover the >expence of this treatment... If you got your insurance to cover this >what did you do? >Thanks, > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 For those of you who lives in states where autistic children qualify for medicaid, Medicaid did pay for all the tests which our primary insurer did not. The work didn't cost us one cent. Our son's neurologist (local) actually ordered the blood work based on the codes Dr. Goldberg gives. Usually your local department of developmental disabilities can tell you if autistic children in your state are covered under TEFRA, and thereby qualify for Medicaid services. Hope this helps someone! Traci changing the world, one word at a time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 In a message dated 4/3/01 8:42:54 PM Eastern Standard Time, pappadia@... writes: > I tried to file insurance on some of the testing ...it > >all came back denied... What are all of you doing to cover the > >expence of this treatment... If you got your insurance to cover this > >what did you do? > The trick here is the diagnosis codes. You need to talk to your doctor about what diagnosis codes to use--or maybe someone on this list might know. I think most insurance companies don't discriminate against the test itself, but instead against the diagnosis. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 I think what everyone needs to realize is that we are treating a medical disorder, not " AUTISM " . Our insurance covers what we are doing just like any other medical condition. Why would an insurance company pay for medical treatments for " autism " . It's not treatable, thankfully what our children have IS TREATABLE. Cheryl _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 Continually re-submitting claims, perhaps with more details. Eventually they will get it!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 Having the right billing code is the key. If you are not using Dr. Goldberg, you can consider calling his office to find out what the billing code is. This may help your insurance company know that they are treating a DISEASE not a developmental disability. Becky Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2001 Report Share Posted April 4, 2001 Thanks Traci, That was interesting about Medicaid. What state do you live in? Michele D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2001 Report Share Posted April 5, 2001 Hi Michele, We live in SC. Medicaid under TEFRA has been a godsend as far as getting services for our kids that our primary insurer will not cover. Because our school district is the Medicaid Licenced Educational Authority in SC, It ultimately reimbursed our school district for seventy percent of the cost of a full time ABA program for our kids. Otherwise, we'd have never gotten the services...it's a great program in this state, but I know that there are several states that do not recognize TEFRA, which honestly seems like a crime to me. The year before we discovered our state had it....we paid eighty thousand dollars on one year of ABA for two boys....geeeez, I'll never own a home again, lol. Traci Traci changing the world, one word at a time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2001 Report Share Posted April 5, 2001 Hi Mercy, We're in Myrtle Beach! Traci changing the world, one word at a time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2001 Report Share Posted April 5, 2001 Oops, I apologize for plugging my book on this list..I forgot to turn off my email signatures before sending. I'm so sorry! Traci Yates-Poff author of " Turn Around Bright Eyes: Visions of Refuge From the War Against Autism, " debuting spring 2002. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2001 Report Share Posted April 5, 2001 Hi Mercy! We have at least three other parents here, and a fourth to start shortly! If I ever get that way, I'll have to drop you an email! We'll do lunch. Traci Yates-Poff author of " Turn Around Bright Eyes: Visions of Refuge From the War Against Autism, " debuting spring 2002. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2001 Report Share Posted April 5, 2001 Traci Where are you in SC? I'm in Greenville Mercy starmuser@... wrote: > Hi Michele, > > We live in SC. Medicaid under TEFRA has been a godsend as far as getting > services for our kids that our primary insurer will not cover. Because our > school district is the Medicaid Licenced Educational Authority in SC, It > ultimately reimbursed our school district for seventy percent of the cost of > a full time ABA program for our kids. Otherwise, we'd have never gotten the > services...it's a great program in this state, but I know that there are > several states that do not recognize TEFRA, which honestly seems like a crime > to me. The year before we discovered our state had it....we paid eighty > thousand dollars on one year of ABA for two boys....geeeez, I'll never own a > home again, lol. > > Traci > > Traci > > changing the world, one word at a time. > > > Responsibility for the content of this message lies strictly with > the original author, and is not necessarily endorsed by or the > opinion of the Research Institute. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2001 Report Share Posted April 5, 2001 Hi Do you ever drive our way? I would love to meet other parents on the list. Maybe we should find out how many parents are in SC and do something about . Mercy - starmuser@... wrote: > Hi Mercy, > > We're in Myrtle Beach! > > Traci > > changing the world, one word at a time. > > Responsibility for the content of this message lies strictly with > the original author, and is not necessarily endorsed by or the > opinion of the Research Institute. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2001 Report Share Posted April 6, 2001 Traci Don't apologize I think it is wonderful. I have a son who is 8 how about you? starmuser@... wrote: > Oops, I apologize for plugging my book on this list..I forgot to turn off my > email signatures before sending. I'm so sorry! > > Traci Yates-Poff > author of " Turn Around Bright Eyes: Visions of Refuge From the War Against > Autism, " debuting spring 2002. > > Responsibility for the content of this message lies strictly with > the original author, and is not necessarily endorsed by or the > opinion of the Research Institute. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2001 Report Share Posted April 6, 2001 In a message dated 4/5/01 9:48:53 PM Eastern Standard Time, clbro66@... writes: > Why would an insurance company pay for medical treatments for " autism " . It's > not treatable, thankfully what our children have IS TREATABLE. > I agree with you. But the way to get these medical treatments paid for is to use diagnosis codes for other things. Like stomach ailments, allegies, immune problems, etc. in TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2001 Report Share Posted April 6, 2001 Traci, Is your child a patient of Dr. G's? Kathy Northern New York Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2001 Report Share Posted April 6, 2001 Mercy, Is your child a patient of Dr. G's? Kathy Northern-New York Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2001 Report Share Posted April 6, 2001 If you need help in starting a Chapter please email me. Kathy - Northern New York Chapter Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2001 Report Share Posted April 7, 2001 Yes, we have been with Dr. G for about 3 1/2 years. And I sometimes feel I am the only one pulling and tugging. When I lecture to students I always end up with phone calls from all over the States inquiring about . Mercy - JOSKAT95@... wrote: > Mercy, Is your child a patient of Dr. G's? Kathy Northern-New York > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2001 Report Share Posted April 7, 2001 Kathy, not yet, although we're working towards that. I think I'd mentioned that in a few earlier posts that travel terrifies our six year old, so we chose to work with a local neurologist, who has been running Dr. G's protocol for us. My boys have benefitted so much. Our youngest (, age 5) appears to be one of those kids that's going to " normalize " . He has days where we truly can't tell there was ever a problem. He blew away his kindergarten readiness test, and his ABA supervisor has quit doing a lot of academic drills with him because he's so far ahead of his peers. Socially...we're getting there, lol. My older boy, , crawled into my lap with a story book, wanting me to read with him last night. He has NEVER ever shown an interest in being read to before, so I'm really thrilled today. Since beginning the protocol (last September), he has shown a real desire to communicate (he uses PECS fluently), and is so much happier a child. We've been able to reduce his depakote dosage to half of what he used to take with no ill effects, and we continue to reduce it slowly down. Our hope is he will soon be able to live seizure free without anticonvulsants due to the long term use of the SSRI's and antivirals. However, I am aware of three other children in our area who are seeing Goldberg, with very good results. Slow, but sure and measurable progress in all of them, I truly believe in the hypothesis. Traci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2001 Report Share Posted April 7, 2001 Kathy, I may be interested in doing this, if you can send me some guidelines or a mission statement for what a chapter does? I imagine theirs a lot of medical community education involved? Thanks Traci Yates-Poff author of " Turn Around Bright Eyes: Visions of Refuge From the War Against Autism, " debuting spring 2002. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2001 Report Share Posted April 7, 2001 Hi , My sons are six and five, both kids, and I also have a neurotypical seven year old princess with an IQ that leaves mommy standing in the dust, lol. I also have a twenty one year old daughter from my first marriage who is extremely brilliant, but also suffers from OCD. Poor kid spends most of her day wiping up glass rings and washing her hands. It interferes terribly with her life goals, and it breaks my heart. I'm trying to encourage her to get the bloodwork done as well. Traci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2001 Report Share Posted April 11, 2001 Are you interested in starting a chapter in your area? Kathy - Northern New York Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2001 Report Share Posted April 11, 2001 Traci, Would you be willing to track down these other families and start a chapter? The only way that we will be able to get the protocol to other children (and I am super glad that your kids are doing so well)! is to work as groups. Strength in numbers, etc., the politics of autism are real and I didn't believe that until I started having to struggle over roadblocks! Kathy Coalition - Northern New York Chapter Quote Link to comment Share on other sites More sharing options...
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