Last updated 2 days 7 hours ago
Due to pressure from ABA practitioners and families across the country, health insurance companies have gradually increased coverage for ABA therapy. Here is an explanation of the controversy surrounding health insurance coverage for ABA.
When health insurance companies are deciding whether to cover a certain treatment, they first have to ensure that the treatment meets certain criteria. In particular, the treatment has to be deemed a health service. The controversy surrounding ABA therapy and health insurance coverage revolves around the question of whether ABA is a health therapy or an educational service. Unfortunately, many health insurance companies have historically categorized ABA therapy as an educational service, and have therefore refused to provide coverage. There is an appeal process available for families whose children undergo ABA therapy but the process can often be long and time-consuming.
- Recent Positive Developments
Thanks to increased awareness about the purpose and success of ABA therapy, more health insurance companies have begun to provide coverage. Recently Blue Shield of California Life & Health Insurance Co. agreed to provide coverage for applied behavior analysis therapy. UnitedHealth has also decided to provide coverage for ABA therapy. Increased evidence regarding the positive effects of ABA therapy has made health insurance companies more sensitive to the needs of families. ABA therapy is an effective treatment option for children with autism with a variety of health benefits. As awareness about the benefits of ABA therapy continues to increase, health insurance companies will follow the example of Blue Shield and UnitedHealth and provide coverage for the treatment.
For more information about health insurance coverage for ABA therapy, call STAR at (805) 624-6982. We provide high quality psychological and ABA services to children and families in the community.
Last updated 8 days ago
Conventional teaching environments involve controlled areas that are specifically for instruction. The teacher stands at the front of the room and the students sit at desks while they receive instruction. Structured teaching environments often require significant stimulus control and can be difficult for some kids to adjust to. Natural environment teaching is an alternative that can help children with autism adjust to day-to-day situations.
Sitting in a structured teaching environment for hours can be difficult for children with autism. Often, the teacher has to spend a significant amount of time on stimulus control, allowing only a little time for instruction. Portability provides more creative freedom and fundamentally changes the dynamic between the student and the teacher. Instead of the teacher dictating to the student sitting in his or her desk, natural environment teaching creates an environment in which the teacher is approaching the student as a guide or instructor.
Unfortunately, running a structured teaching environment often involves negative reinforcement. When a student misbehaves, the teacher has to respond negatively in order to maintain the teaching environment. This can often leave students discouraged and unable to pay attention. Natural environment teaching changes the dynamic between the teacher and student. Instead of employing negative reinforcement to encourage good behavior, instructors in natural environment teaching only employ positive reinforcement. This conditions the instructor as reinforcer. Instead of punishing bad behavior, a reinforcer encourages habits of good behavior.
To learn more about how natural environment teaching can help your child with autism, call STAR at (805) 624-6982. STAR California is a division of Support and Treatment for Autism and Related Disorders. We pride ourselves on providing quality psychological and ABA services to families in the community.
Last updated 12 days ago
IPad Covered by Insurance
Autism & 5 steps to getting an iPad covered by insurance Dawn Sconfienza Gaita
As a parent of a child with special needs, I understand firsthand the financial struggles that come with the job. When I discovered the iPad and the benefits it could have for my son, it became my mission to find a way to provide one for him. This is a simplified version of the steps I took in getting my iPad covered by insurance, and it is my hope that others can benefit from this information.
1. Check your medical benefits for your “Durable Medical Coverage.”(Mine covered 50%, but since we had already met our out-of-pocket max, they covered at 100%)
2. Phone your insurance company and ask, “Please assign me to a case manager that is experienced with special needs children.”
3. After you are provided a case manager, explain that you need the iPad as an augmentative communication device INCLUDING the Proloquo2go App (or TouchChat, OneVoice, TapToTalk, etc.) Provide comparison costs to a more expensive system such as the Dynavox, and remind them that you are opting for a more cost-effective device. Focus on Proloquo2go (or your chosen Aug Comm app) and that it is being introduced by Speech Therapists and OT’s in public schools for special needs kids, as well as in private therapy… say nothing negative at all. If they have never heard of the Proloquo2go program, ask for their email address to send them a link and/or encourage them to visit the proloquo2go website. You could also provide links to the Youtube demonstrations provided by proloquo2go (or app demos provided on a4cwsn.com). Be sure to ask the case manager for all the necessary approval codes and coverage information so you are aware and comfortable with any out-of-pocket expenses you may incur. They may tell you “NO” at this point. If they do, ask them to email or fax you a letter of denial immediately. Local Developmental Disability Divisions/Boards and many private funding organizations will require a medical insurance denial to apply for funds, so getting this letter can be very helpful. Don’t get discouraged, there are still more ways to get funding!
4. Find supporting documentation and case studies to include with your claim. Google articles on “iPads for children with special needs” or “benefits for children with [your child’s specific condition] and iPads,” etc.
5. Copy your most recent speech evaluation and IEP if it indicates anything helpful. And, have every doctor, therapist, school personnel or anyone else write a letter supporting your child’s need for an “Augmentative Communication device such as the iPad with Proloquo2go.”
The more information you can provide, the less likely they will argue against the need. My personal insurance required that I pay for the device a
nd then submit a claim form for reimbursement.
When submitting your Claim for Reimbursement:
1) What you purchased,
2) What is was for
3) How it should be coded and
4) That it should be treated as an IN NETWORK provider.
Include the notes (Name and Dates/Time of phone calls) from your conversation with your case manager.
Supporting Documents from Google, etc.
Letters from Doctors, Speech Therapists, etc.
Receipt of the Device and the AugCom App
SAMPLE LETTER OF RECOMMENDATION FOR IPAD – PHYSICIAN/MEDICAL NECESSITY
SAMPLE LETTER OF RECOMMENDATION FOR IPAD – FROM PRIVATE SPEECH THERAPIST
Courtesy of Parenting Special Needs
Last updated 15 days ago
When a child is diagnosed with autism, parents may feel that it’s their fault. If you’re one such parent, you should understand that autism has nothing to do with your parenting ability. Furthermore, you have the power to seek treatment through applied behavior analysis. Click on the links below to learn more about autism and autism treatment options.
- There are several social skills that children need to succeed. Learn what they are at this page from the National Education Association.
- Do you understand the basics of autism? If not, head over to this page from PubMed Health.
- Autism diagnoses are at an all-time high. Read this article from Reuters to learn more.
To learn more about autism treatment options in Los Angeles, visit the following links or call STAR at (805) 624-6982.
