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I certainly hope that works for some, but I have

United Healthcare. I had multiple prescriptions for

behavioral therapy from several M.D.s and specialists.

I had volumes of supporting evidence and studies for

ABA. Also, letters from the Meyer Clinic and

behavioral specialists that I sent to United.

It did not matter to United. We were denied coverage,

denied on appeal, and in most cases it is a waste of

time to complain to TDI. They are powerless to take

any action.

In my experience, denial by insurance companies is

arbitrary and capricious. We were even denied speech

therapy because " autism is not a congenital disorder "

according to United. HUH????? So she contracted it?

How? By exposure? Who said you can't burn both ends

of a candle? You can if you are an insurer...

What we need is a class action suit.

Oops, sorry. Rant alert. Are my fangs showing?

--- Arzu & Reza Forough wrote:

> ,

>

> In order for you to educate your insurance company

> on the services that

> your child needs, first you need to educate a

> physician, so that he/she

> will prescribe the needed therapies, then you have

> to provide the

> insurance company supportive evidence on why this is

> needed and if

> they're not contracted with a provider already, then

> you need to find a

> provider and ask for an out-of-plan or out of

> network coverage. Hope

> this helps.

>

> Arzu

>

>

>

>

> On Nov 10, 2005, at 7:50 AM,

> Texas-Autism-Advocacy

> wrote:

>

> > PDD and Insurance coverage

> >

> > RE:

> >

> > Expands the Article 3.51-14 definition of 'serious

> mental illness' to

> > include pervasive developmental disorders,

> obsessive-compulsive

> > disorders and depression in childhood or

> adolescence. Coverage of

> > serious mental illness becomes a mandated offer

> for small employers

> >

> >

> > Maybe this has already been said but for us it's

> not that PDD is not

> > covered - it IS under Mental Health - it's that

> the services he needs

> > are NOT covered.... O/T, Social Skills therapy,

> speech therapy. We

> > can have visits for a psychiatrist or psychologist

> and get all the

> > med's he wants. For us we don't get the TYPE of

> coverage he needs.

> >

> > Wellen

> > (H)

> > ©

> > Ask me about my realtor...The Right Team....Real

> Estate and More!

> > www.TheRightTeam.com

> >

>

>

__________________________________

Yahoo! Mail - PC Magazine Editors' Choice 2005

http://mail.yahoo.com

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