Monday, July 13, 2009

Blessed with Autism and Christina N. Peck

Today’s Disabilities Leadership Council spotlight is on the organization Blessed with Autism (http://www.blessedwithautism.com/) and its founder, Christina N. Peck. The organization helps parents of children on the autism spectrum recoup the considerable costs of therapy from their health insurance providers. In a recent interview, Christina explained why it is so difficult for parents to get these services paid for by insurance. Most of the providers of these services, which include speech therapy, physical therapy, occupational therapy, and behavioral intervention, are not in any of the health networks set up by major health insurance providers. Since they are out-of-network, parents have to pay for the services up front and out of their own pocket, and can only recover costs if their plans include out-of-network benefits. These costs are especially difficult to recoup if parents don’t have a PPO insurance plan. Christina said, “It is easier to recoup costs from private insurers than from Medicaid; you can go out of network.” Parents with an HMO can also find it tough to get reimbursement; Christina said that these parents “should get new [private] insurance. In the long run, the therapy can cost $90,000 and with this insurance you can get back maybe $50,000 of that.” Christina said that employer-provided PPO plans allow one to recoup many of the costs of therapy. This entire system is made even more difficult by the fact that there are many differences in plans not only from company to company, but even within different plans of the same company!

Christina explained how parents can claim reimbursement for their child’s therapy. She said, “The key is diagnosis codes for the type of therapy. You have to code for the medical condition being treated, not for autism. Quite often, providers don’t even put the billing codes on the bill. Parents must submit the bills and proper forms to their insurance company using codes provided by Blessed with Autism. If you submit a bill that is coded for autism, there is no chance of receiving reimbursement.” Coding for the medical condition means that the bill will be coded for the specific problem being treated, not autism. For example, for speech therapy, the bill would be coded as treatment for a speech impediment, not as treating for autism.

Christina’s book, Blessed with Autism, contains all the details on how to deal with different kinds of insurance and what the different codes and procedures are to deal with every type of therapy and treatment. The book is available on her website, http://www.blessedwithautism.com/. Christina’s hope is that, using the book, parents can complete the entire process on their own. For those parents who need help, Christina’s colleague Yvonne McNamee runs a consultation service through the Blessed with Autism website. Christine said that her main goal is to “empower people to do it themselves.”

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