Re: insurance

[Guest guest]

-

I also wanted to add they keep referring me to mental health and not

one person there knows anything about HB 1919. Thank you

-- In Texas-Autism-Advocacy , " rachelsteppy "

wrote:

>

> Does anyone have any advice on how to bill your insurance for ABA

> services? The school my son is attending does not bill insurance. I

> have heard of parents being reimbursed, but I don't know what forms

are

> needed or the codes needed for billing. My insurance company has not

> been any help and even asked me " what is Autism? " ! Any information

> would be greatly appreciated. Thank you

>

[Guest guest]

I am being reimbursed thru United Behavior health (mental health) for aba and

the service is listed as miop misc. service

-

rachelsteppy wrote:

-

I also wanted to add they keep referring me to mental health and not

one person there knows anything about HB 1919. Thank you

-- In Texas-Autism-Advocacy , " rachelsteppy "

wrote:

>

> Does anyone have any advice on how to bill your insurance for ABA

> services? The school my son is attending does not bill insurance. I

> have heard of parents being reimbursed, but I don't know what forms

are

> needed or the codes needed for billing. My insurance company has not

> been any help and even asked me " what is Autism? " ! Any information

> would be greatly appreciated. Thank you

>

[Guest guest]

It all depends on your insurance. If your company is self insured they

do not have to follow state laws therefore HB1919 will not have any

effect on wether or not they will cover Autism treatment ABA, bio-

medical or any other type of therapy.

The insurance company requires several things listed in the invoice for

consideration. We hired a billing company to submit our insurance

claims and what they do is the following:

They list the DR name with their BCBA supervision #, the name of teh

patientien beeing treated and teh code or diagnosis he is beeing

treated for 299.9 Unspecified Pervasive Developmental Disorder and

315.31 Language Disorder.

Then the therapy hours are billed under two codes:

90808 Supervision Clinical Counseling

90806 Therapist Clinical Counseling

Showing the total hours billed and the amount billed for each.

For his OT they bill insurance under diagnosis 781.3 and teh procedures

for therapeutic Activities under procedure code 97530.

Then again the DR license and EIN are always listed on every invoice.

Providing this codes and DX our insurance company has reimbursed us,

note that my company is self insured so other insurance providers my

not cover the treatment or these diagnosis and or codes.

Hope this helps.

>

> Does anyone have any advice on how to bill your insurance for ABA

> services? The school my son is attending does not bill insurance. I

> have heard of parents being reimbursed, but I don't know what forms

are

> needed or the codes needed for billing. My insurance company has not

> been any help and even asked me " what is Autism? " ! Any information

> would be greatly appreciated. Thank you

>

[Guest guest]

By the way, most large companies are self-insured. They don't cover

autism. We have one. Crock of S**T! Those are the ones that can

afford it!

> >

> > Does anyone have any advice on how to bill your insurance for ABA

> > services? The school my son is attending does not bill insurance. I

> > have heard of parents being reimbursed, but I don't know what forms

> are

> > needed or the codes needed for billing. My insurance company has not

> > been any help and even asked me " what is Autism? " ! Any information

> > would be greatly appreciated. Thank you

> >

>

[Guest guest]

Aetna is TOUGH. I heard that they actually developed an internal policy

statement that autism isn’t a disorder at all so they don’t have to cover

it!

S.

The significant problems we have cannot be solved

at the same level of thinking with which we created them.

Albert Einstein

From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of Cookie

Sent: Wednesday, May 21, 2008 9:23 PM

To: Texas-Autism-Advocacy

Subject: [sPAM][sPAM] Re: Insurance

We have Aetna. I've not seen one penny come from AETNA, only refusals

and we are self-insured.

-

-- In HYPERLINK

" mailto:Texas-Autism-Advocacy%40yahoogroups.com " Texas-Autism-Advocacy@yahoog

roups.com, " Singleton "

wrote:

>

> Actually I heard of several self funded policies covering it. One

woman I

> heard speak last year, her family had a self insured policy through KLM

> (???? Can't exactly remember the company name) but they paid the

FULL cost

> for the ABA program with only a $30 co-pay a month—that's what I

remember

> the mom saying.

>

>

>

> In fact, United Behavioral Health, which serves most self funded

policies,

> has been interviewing local ABA clinics in Houston.

>

>

>

> So it boils down to which company is opting to carry it and which

aren't.

> With a self-funded policy, the decision makers are AT the company,

and so

> are a lot more accessible than insurance executives running a fully

funded

> program.

>

>

>

> S.

>

>

>

>

>

> The significant problems we have cannot be solved

>

> at the same level of thinking with which we created them.

>

> Albert Einstein

>

>

>

> From: HYPERLINK

" mailto:Texas-Autism-Advocacy%40yahoogroups.com " Texas-Autism-Advocacy@yahoog

roups.com

> [mailto:HYPERLINK

" mailto:Texas-Autism-Advocacy%40yahoogroups.com " Texas-Autism-Advocacy@yahoog

roups.com] On Behalf Of Cookie

> Sent: Tuesday, May 20, 2008 10:40 PM

> To: HYPERLINK

" mailto:Texas-Autism-Advocacy%40yahoogroups.com " Texas-Autism-Advocacy@yahoog

roups.com

> Subject: [sPAM] Re: Insurance

>

>

>

> By the way, most large companies are self-insured. They don't cover

> autism. We have one. Crock of S**T! Those are the ones that can

> afford it!

>

>

> > >

> > > Does anyone have any advice on how to bill your insurance for ABA

> > > services? The school my son is attending does not bill insurance. I

> > > have heard of parents being reimbursed, but I don't know what forms

> > are

> > > needed or the codes needed for billing. My insurance company has

not

> > > been any help and even asked me " what is Autism? " ! Any information

> > > would be greatly appreciated. Thank you

> > >

> >

>

>

>

>

>

> No virus found in this incoming message.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.21/1456 - Release Date:

5/20/2008

> 6:45 AM

>

>

> No virus found in this outgoing message.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.24.0/1459 - Release Date:

5/21/2008

> 5:34 PM

>

>

>

>

[Guest guest]

>

> Aetna is TOUGH. I heard that they actually developed an internal policy

> statement that autism isn't a disorder at all so they don't have to

cover

> it!

, it is your employer that decides what coverage to purchase.

I have Aetna, have had for some years, and they are covering

everything autism. I have unlimited speech therapy with no

developmental exclusion, which was my employers decision, not the

insurance company's.

Ruth

[Guest guest]

A stupid doctor wrote a diagnosis of " emphysema " on my chart because I

smoked. Never did X-rays, and tests. I was then denied by three

insurance companies after my Cobra ran out. Should have sued her. I

don't know of a way to remove a wrong diagnosis from the system.

Luckily, I married insurance.

Marti

> Hi ya'll. Well we just got our new insurance. It says my waiting

> period was voided because I was coming onto the same company as I had

> before.... so they say they will cover thyroid, then on the back page

> it says we will not cover any upcoming complications such as

> surgeries... so... do they cover the meds??? I mean, thats WHY I

> need insurance!! Plus, they denied my husband's application because he

> has bi polar. Is there any way to have them reconsider, or would

> anyone cover you if you had bi polar? The person who diagonsed

> him... well, right after that he saw someone else who said he didn't

> have that... so... what do I do? Will they reconsider the

> application, what do you guys think?

>

[Guest guest]

My step dad is in the biz but, not that kind of insurance. I can get some help from him but right now he is in NY!! Thanks for replying to me!! Yeah on the wrong diagnosis.. we know so much more than the docs sometimes lol

> Hi ya'll. Well we just got our new insurance. It says my waiting

> period was voided because I was coming onto the same company as I had

> before.... so they say they will cover thyroid, then on the back page

> it says we will not cover any upcoming complications such as

> surgeries... so... do they cover the meds??? I mean, thats WHY I

> need insurance!! Plus, they denied my husband's application because

he

> has bi polar. Is there any way to have them reconsider, or would

> anyone cover you if you had bi polar? The person who diagonsed

> him... well, right after that he saw someone else who said he

didn't

> have that... so... what do I do? Will they reconsider the

> application, what do you guys think?

>

------------------------------------

[Guest guest]

This insurance stuff is another reason why I recommend Enterolab. If

you pay out of pocket and don't submit to insurance, then that

diagnosis isn't on file. So, you get two benefits - you can improve

your health with the GF diet and not have the bias from the

insurance companies. This is particularly important anytime you do

gene tests and this is one of the top bio-ethical issues - would it

be right to deny insurance just because you have the genetic

predisposition for disease x.

Also, there are also university and non-profit research

organizations that do some of these tests for free - in Chicago, the

university there runs free celiac blood tests once a year. There's a

university in South Carolina that runs the tests to determine if you

have the gene associated with Emphysema (that runs in my family -

anyone that has smoked on my mother's side has emphysema by the time

they're 50) - the test is " Alpha-1 Antitrypsin " - the test is rarely

run even for folks with lots of respiratory issues (e.g.,

bronchitis, pneumonia, etc.). Also, folks with this are the ones

that are sensitive to chemicals, environmental toxins, etc. And,

one of the reasons they will run this test for you is to avoid this

getting on your health records.

B.

>

> > Hi ya'll. Well we just got our new insurance. It says my

waiting

> > period was voided because I was coming onto the same company as

I had

> > before.... so they say they will cover thyroid, then on the

back page

> > it says we will not cover any upcoming complications such as

> > surgeries... so... do they cover the meds??? I mean, thats

WHY I

> > need insurance!! Plus, they denied my husband's application

because he

> > has bi polar. Is there any way to have them reconsider, or would

> > anyone cover you if you had bi polar? The person who diagonsed

> > him... well, right after that he saw someone else who said he

didn't

> > have that... so... what do I do? Will they reconsider the

> > application, what do you guys think?

> >

>