Behavior specialist

April 3, 2011

my son gets one hour 1x every 2 weeks and I can say this is not enough. I liked it better when it was weekly but we are only allowed 22 visits per year

Theresa StoopsCoordinator OfFlorida F.A.S.D. Interagency Action Group 850-408-3789 God Bless All Military Families We All Hope On Your Safe Return Home.

April 5, 2011

I am also in NJ. Last year we went to a private therapist once a week. That

was good for us- but some weeks I felt that another session would've helped. We

paid for the sessions up front and then submitted to our insurance for

reimbursement at the out-of-network level since she was not in network. Find

out of you have out-of-network benefits and/or mental health benefits. Ask for

things like " is pre-certification needed? " and " do I need a specific code on the

billing to get reimbursed? " " do I need a referal form/ " " Do I need a Treatment

Request Form? " etc etc...

last summer it was a full time job getting reimbursed for all our appts! lol

***** Most of all***** keep calling the insurance co and ASK ASK ASK as many

questions as you can! It is a game for them! They will not willingly give you

the info you need to get the coverage- but you need to ask them. It is so

frustrating. We fought our insurance co. many many times and we have won. In

NJ- there was a new law passed last year that has to do with insurance coverage

for individuals with autism.

Good luck to you!

>

> Hi the insurance doesn't pay for. Any mental health we live in nj they pay the

therapist I guess it depends on insurance company we pay high copay for therapy

sorry. I didn't help. Wish you luck

> Sent via BlackBerry from T-Mobile

>

> ( ) Behavior Specialist

>

> I hope someone out there has some wisdom to share about getting the

> behavioral support we need. My son, 12, was recently diagnosed with AS. We

> are still waiting for the Child Study Team to convene, so an IEP is still a

> long way away - probably not until September at this rate. We live in NJ,

> and I heard that there is a NJ law that requires all insurance companies to

> cover Behavioral specialists. However, our insurance is part of a group

> policy that was purchased in NY, where my husband's company has its main

> office. The insurance company says they are not required to cover these

> specialists, by law, because the law is " not extraterritorial. "

>

> I know each child is different, but I need to get a sense of how often (on

> average at least) a child with strong needs for a behaviorist should be

> meeting with a one. Are these the kind of services typically provided for

> in an IEP? Any suggestions about how to get the insurance company to cover

> it?

>

April 6, 2011

Hi There - We are in PA and have the same kind of insurance mandate law issue

where insurance companies are not required to pay for autism services if they

are out of state or self insured. Consequently, people are still left with no

coverage.

In PA, we use Medical Assistance to access behavioral services. Is this

something you can do in New Jersey? Another option would be to pursue

behavioral support via the IEP team. Are the behaviors interfering with his

learning or the learning of others? I just read a great article about getting

services and FBAs done by the school...Here is the link

Guidelines and Observations Regarding Functional Behavioral Assessment ( " FBA " )

http://specialedlaw.blogs.com/home/2005/12/guidelines_and_.html