Uncovering The Secrets Of Getting California Health Insurance To Pay For Autism Treatments

Autism is a neurobiological condition which is often responsive to Applied Behavior Analysis (ABA) therapy, yet most health insurance companies fail to provide this medically necessary service to their members. For the past 7 years, AB 88, known as the Mental Health Parity Act, has been on the books in California. This piece of legislation obliges private health insurance companies to offer treatment services for enrolled members who are diagnosed with autism; but actually getting health insurance to pay for these interventions is a challenge. Up to this point, the advocacy movement to enforce this law has been relatively quiet. Most parents find that insurance companies are not willing to cooperate or give coverage for autism without a fight. To date, there are at least 15 cases in the state that have gone through the full process of request, denial, appeal, and independent medical review (IMR) resulting in families with autistic children receiving insurance funding for intensive ABA services.


Wellspring is eager to assist families through this process, which if successful will provide families with options for treatment as well as alleviating the Regional Center of some of the burden of responsibility for funding of such services.


Wellspring is excited to announce a free seminar for parents that want to use their health insurance to pay for autism treatments. The featured speakers are Dr. Karen Fessel and Feda Almaliti, who have successfully secured private insurance for the funding of autism treatment for their children.


Karen Fessel, Dr PH


Autism Parent and Advocate


Karen Fessel is the proud parent of a 14 year old son with Asperger's, and a 10 year old typical daughter. Karen has a Doctorate in Public Health from UC Berkeley. She has served as a parent advocate on the Autism Advisory Workgroup. She fields questions on an insurance help website, and serves on the Special Ed Advisory Committee of the Lafayette School District. Karen has filed and won several complaints and IMRs against three different insurance companies. Many families have benefited from Karen's personal guidance and have secured insurance coverage for their child's treatment.


Feda Almaliti


Autism Parent and Advocate


Feda Almaliti is the proud parent of 3 boys ages 4 through 10. Her youngest son was diagnosed with autism at 18 months, and since then she has fought tirelessly to get him the help he needs. Recently she fought and won an IMR that resulted in Kaiser paying for 26 hours of ABA, 2 hours of speech therapy, and 2 hours of occupational therapy, weekly. Feda's battle with Kaiser has been featured on local ABC and CBS news stations. Feda is dedicated to helping other parents because "It is the parents who have helped and supported me in my journey through autism."


Their presentation will be invaluable to families who have private insurance and who would like to pursue their insurance carrier for the vital health care supports that their autistic children need. This team has lead parents in some of the biggest wins in the state of California related to autism: securing 40 hours a week of ABA paid by insurance!


Source: Wellspring

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