NJ Parity Bill for Mental Health, ABA, & insurance

[Guest guest]

Cheryl,

Thank you for sharing your experience with us. This coverage will come

(just as

parity came) and it will be through the efforts of the people like you

and others on the list. I only wish it could come today.

I too will keep checking.

Anne

NJ Parity Bill for Mental Health, ABA,

&

> > > insurance

> > >

> > >

> > > Is anyone familiar with interpretations of the NJ Mental

Health

> > > Parity Bill? Can it be used to get insurance companies to pay

> for

> > > home ABA programs? Although autism is a neurological

disorder,

> > this

> > > law clearly includes PDD/autism under the label of mental

> illness,

> > > for which coverage should be provided. Any insights on thi >>

> > >

> > >

> > > Mosaic-List is not confidential. Remember when you post it goes out

to

> > all members of the group. Mosaic meets the 2nd Thursday morning

> (Ridgewood

> > and Noble on 2nd floor at the computer section sitting area)

and

> the

> > 3rd Wednesday evening (The Arc in Hackensack) of every month. All are

> > welcome.

> > >

> > >

[Guest guest]

Kathy,

You should definitely use all your current diagnosis' & autism. You

should also throw the NJ Parity Law lingo. United Healthcare is paying

other members.

Anne Q

NJ Parity Bill for Mental Health, ABA,

&

> >> > insurance

> >> >

> >> >

> >> > Is anyone familiar with interpretations of the NJ Mental

Health

> >> > Parity Bill? Can it be used to get insurance companies to pay

> >for

> >> > home ABA programs? Although autism is a neurological

disorder,

> >> this

> >> > law clearly includes PDD/autism under the label of mental

> >illness,

> >> > for which coverage should be provided. Any insights on thi >>

> >> >

> >> >

> >> > Mosaic-List is not confidential. Remember when you post it goes out

> to

> >> all members of the group. Mosaic meets the 2nd Thursday morning

> >(Ridgewood

> >> and Noble on 2nd floor at the computer section sitting area)

and

> >the

> >> 3rd Wednesday evening (The Arc in Hackensack) of every month. All are

> >> welcome.

> >> >

> >> >

[Guest guest]

,

You bet they are waiting for you to give up! Go back at them again - send

every letter certified mail return receipt and get all the support you can

from your doctors, therapists, etc. Keep appealing and appealing until they

pay!

Cheryl

In a message dated 3/9/01 3:21:24 PM Eastern Standard Time, 0567@...

writes:

<< n a message dated 3/9/01 3:02:23 PM Eastern Standard Time,

salbrecht@... writes:

> Although autism is a neurological disorder, this

> law clearly includes PDD/autism under the label of mental illness,

> for which coverage should be provided.

hi jane..i did some reseach on this a while ago being that my son is over 3

and therefore, the insurance company states that the school district should

pay for this..the insurance company said its mental illness and under nj kid

care, aetna us healthcare ..there is a cap for the amout they will allow for

mental illness..so they told me to check kidcare because they only cover the

hmo and mental illness would come under medicaid..but i think the cap is

with

any insurance company..so needless to say i felt like a pink pong ball going

back and forth between the two.

there was a case i think last year.i'm not sure when..that parents of a

child

were experiencing the same problems with an insurance company not wanting to

pay because of its mental illness classification and it should be covered

by

the portion that has a payout cap..anyway it went to the supreme court and

was determined that autism was not mental illness it was biological so

therefore it should not be covered by mental illness but biological.

my outcome wasn't favorible though..the insurance company i dealth with kept

pushing me back to the school district because he was over three..asnd i

kind

of dropped the ball there..after numerous calls to both kidcare, medicaid

and

aetna i just got so frustrated i gave up.i bet what they were hoping for!!!

i'm in the process of having an independant evaulatuation done by the search

program at robert wood johnson university hospital in new brunswick, which

is

being cover by my insurance company..so i'm sure i will be in pursuit of

this

again soon..

please keep us up to date ..diana

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

In a message dated 3/9/01 3:02:23 PM Eastern Standard Time,

salbrecht@... writes:

Although autism is a neurological

disorder, this

law clearly includes PDD/autism under the >>

[Guest guest]

Dear Anne,

I submitted all the bills with the hourly fee. I have been told by Human

Resources at the company (employer) that they authorized the payment (I did

receive a denial letter from the insurer). When the payment was taking so

long, the HR rep had to keep following up. I was then told (news to her too)

that the employer actually had to wire transfer the funds to the insurance

company. This has been one long and tedious process - let me tell you!

Anyway, they have finally wired transfer the funds and they will be cutting

the check on Monday!

But, I wonder if they are really setting a precedent since I did receive a

letter of denial and the employer authorized the check??? Did you tell your

administrative people that it was the employer who made the exception?

I would love to have you snoop further - but just let me get that check in my

hands - when we are done with the matter - it's all yours!

THanks.

Cheryl

In a message dated 3/15/01 9:13:40 PM Eastern Standard Time,

happy-1@... writes:

<< Hi Cheryl & All,

As we've been discussing, I checked the 97770 code. It is listed as

" other alternative medicine procedure (97780 is acupuncture). The code

97770 has the following description:

" Development of cognitive skills to improve attention, memory, problem

solving, includes compensatory training and/or sensory integrative

acitivites, direct (one to one) patient contact by the provider, each 15

minutes "

Pretty good description overall. My model claim denied in all 6 major

carriers who participate in the test model for " non-covered benefit " .

However, my

model claim pended (processing stopped for human resolution) in two smaller

carriers. That doesn't mean it will eventually pay, it just means that it

couldn't automatically deny since the contract might cover some alternative

therapies.

Cheryl, how did you bill the services? Did you bill for one unit per hour

or 4 units (15 mins) per hour? Did you have any limitations placed on the

payments (i.e. approved amounts,etc)?

My med policy folk's advised that by providing you with an administrative

exception, the carrier did indeed open to the door to precendence so that

other members covered by them could ultimately submit. If you want to email

me privately with some details (like carrier name)...I could snoop even

further

It's certainly worth a try!

Anne Q

NJ Parity Bill for Mental Health, ABA, &

> > insurance

> >

> >

> > Is anyone familiar with interpretations of the NJ Mental Health

> > Parity Bill? Can it be used to get insurance companies to pay for

> > home ABA programs? Although autism is a neurological disorder,

> this

> > law clearly includes PDD/autism under the label of mental

illness,

> > for which coverage should be provided. Any insights on thi >>

> >

> >

> > Mosaic-List is not confidential. Remember when you post it goes out to

> all members of the group. Mosaic meets the 2nd Thursday morning

(Ridgewood

> and Noble on 2nd floor at the computer section sitting area) and

the

> 3rd Wednesday evening (The Arc in Hackensack) of every month. All are

> welcome.

> >

> >

[Guest guest]

Cheryl I would like a copy of that bill also.

[Guest guest]

Cheryl,

Thank's for the info. I didn't tell my advisors that it was the

employer who is intervening...that probably does change it.

We'll wait until that check is not only in hand, but cleared before I

snoop....

Anne

NJ Parity Bill for Mental Health, ABA,

&

> > > insurance

> > >

> > >

> > > Is anyone familiar with interpretations of the NJ Mental

Health

> > > Parity Bill? Can it be used to get insurance companies to pay

for

> > > home ABA programs? Although autism is a neurological

disorder,

> > this

> > > law clearly includes PDD/autism under the label of mental

> illness,

> > > for which coverage should be provided. Any insights on thi >>

> > >

> > >

> > > Mosaic-List is not confidential. Remember when you post it goes out

to

> > all members of the group. Mosaic meets the 2nd Thursday morning

> (Ridgewood

> > and Noble on 2nd floor at the computer section sitting area) and

> the

> > 3rd Wednesday evening (The Arc in Hackensack) of every month. All are

> > welcome.

> > >

> > >

[Guest guest]

In a message dated 01-03-17 10:28:54 EST, you write:

<< Cheryl,

Thank's for the info. I didn't tell my advisors that it was the

employer who is intervening...that probably does change it.

We'll wait until that check is not only in hand, but cleared before I

snoop....

Anne >>

Anne,

Thanks - I'll will let you know hopefully next week when I receive the check.

Cheryl