Mental Health & Autism Health Project Insurance Services for People with Autism
Services that we offer
Appeals and Requests for Independent External Review
We assist families with loved ones with autistic spectrum disorders obtain medically necessary treatments through insurance. We primarily work to help families obtain coverage for speech therapy, occupational therapy, physical therapy, behavior health treatment, and social skills therapy. We handle health plan denials (both for coverage and medical necessity), and regulatory intervention. We do the initial appeals, and we write requests for independent external review with state regulators, as well. We work in MANY states, and have a high success rate. For self-funded ERISA plans, we often refer to attorneys after the appeals phase is exhausted. The attorneys that we work with have very high success rates.
Single Case Agreements
Often health plans do not have an adequate network of providers that can with the ASD population. When we encounter situations like this, we encourage families to thoroughly investigate their network. If nobody with the appropriate expertise is available, we encourage them to call back the plan and request a single case agreement with a non-network provider. Sometimes even though families have taken all the right steps, they still encounter problems. We step in and file grievances, appeals, and regulatory intervention.
Problems with billing
If there were problems with billing or coding, we can review documents, determine the problem, and with permission from providers, re-do and resubmit bills.
We offer speaking engagements and trainings to community organizations, parent support groups and others that want to learn more about accessing insurance.
Advice to Providers
We are happy to work with your provider and advise them on what they need to know to be able to work effectively with insurance.
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