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| Insurance and Practice Considerations for Service Delivery to Individuals With Autism Spectrum Disorder |
| Sunday, May 27, 2018 |
| 11:00 AM–11:50 AM |
| Manchester Grand Hyatt, Seaport Ballroom H |
| Area: AUT |
| Instruction Level: Intermediate |
| Chair: Karen Fessel (Mental Health & Autism Insurance Project) |
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| Working With Insurance: Writing Successful Appeals and Working With State Regulators |
| Domain: Service Delivery |
| KAREN FESSEL (Mental Health & Autism Insurance Project) |
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| Abstract: With nearly all US states now having insurance autism mandates, more and more providers are turning to health insurance as the primary funder of ABA services for Autism. This talk will lay out a template describing what providers need to know when facing insurance denials. We will use specific, real life cases and discuss how providers can address them. We start by looking at the specific written reason given for denial. Common reasons which we routinely encounter, many of which will be discussed include location (school vs home), disputes about hours of coverage, duration of the program, not benefitting from services, no longer needing services, parental involvement, as well as disputes about payment and coverage. When reviewing reports, health plans often look for descriptions of progress balanced with continued description of deficit and need. This can be highlighted in the appeal, depending on the stated reason for denial. Health plans typically cite their own guidelines in issuing denials, some of which are overly restrictive. A series of recent legal actions have brought some of this to attention -- shortcomings can be addressed and guidelines developed by professional bodies can be cited instead. When and what type of literature to cite and/or include will also be discussed. Even when done right, health plans typically uphold their own denials. Often the external review process is where real "justice" occurs. We will discuss what to include with external reviews, how the process works, and what types of plans are typically supported. Building relationships with state regulators and legislators is important. Finally, we will examine some of the laws which confer protection, including the Federal Mental Health Parity and Addiction Equity Act, and many sections in the Affordable Care Act. |
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CANCELED: #notallaba: Toward an Ethical and Socially Valid Model of Services |
| Domain: Service Delivery |
| ANN BEIRNE (Global Autism Project), Cailey Rodgers (Global Autism Project), Michelle L. Zube (Caldwell University) |
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| Abstract: As the social media presence of autistic self-advocates becomes more pronounced, how can the behavior analytic community respond to the issues that are raised? In our efforts to advocate for evidence-based services, how can we ensure the social validity of those services? How can we effectively disseminate the benefits of applied behavior analysis and also be conscientious of the concerns of the marginalized groups that we serve? These presentations address the need for advocacy that is focused on addressing the needs of the autistic community and the need for examining our own behavior as professionals who serve them. |
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