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July 2018

How Did We Get Here?

A Perspective on Residential Therapeutic Treatment

Parents’ dreams for their children seldom include placing them away from the family home before college or adulthood. Yet that is the complicated choice many parents face when their teenagers’ behavioral and mental health reaches a crisis point, whether due to an existing disability, or when a young person develops new struggles that put them at risk. The increasing number of young people with mental health challenges has been well documented. Nearly 1 in 5 young people aged 13-18 years experience a severe mental disorder at some point during their life.  See the full infographic from National Alliance Mental Illness (NAMI) here.

Copyright National Alliance on Mental Health www.nami.org

Not all teenagers and young adults with these challenges will need residential placement. If they haven’t responded to outpatient treatment, medication therapy or are at risk of harming themselves or others, placement outside the home may be warranted. Children with an existing disability, like Autism Spectrum Disorder, with an increase in self-injurious or other risky behavior that is not being effectively addressed in their school placement, may also need a more restrictive setting.

Read the full article

Complaints About ABA Providers

Our office has received an increasing number of phone calls recently from families with children with autism that have complaints about the quality of their ABA providers. While we care about our families and the quality of the health care that they receive, we typically get involved when there are disputes with your health plan about what is medically necessary, or when your health plan is not following consumer protections under the law.

First, try to address your concerns directly with the ABA provider by discussing in person or by phone. If this doesn’t work, outline your complaint in writing. You should include specific examples of your complaint and any dates or times associated with the issue. For example, if a therapist consistently arrives late of fails to show up, document those incidences and include them in your letter. While some providers have their own toll-free complaint or customer service line, it is always a good to document your concerns in writing and then follow up with a phone call.

If you are unable to resolve the conflict with an ABA provider, it may be appropriate to contact the Behavior Analyst Certification Board (BACB). The BACB has a long list of appropriate behaviors that certified behavior analysts must abide by. According to their Ethics code, Behavior Analysts responsibility to clients include: operating in the best interest of their clients, providing effective treatment, and avoiding interruption of service, among other things. For more details, see Professional and Ethical Compliance Code for Behavior Analysts.

Read the full article

MEET OUR NEW STAFF

Allison Clark, Patient Advocate

Heather Morris, Advocate

Read their full bios on our About Us page.

CASES WE HAVE WON

MHAIP Recovered over 10k for Ambulance Services for Client with Eating Disorder

MHAIP was able to recover over $10,000 from Blue Shield of CA for a San Mateo teen girl with eating disorders who was transferred from an eating disorders program to a cardiac unit, after developing urgent cardiac problems.

MHAIP Recovered over 93k for 11 Week Stabilization and Assessment

A 23 year old Alameda County, CA man with autism and severe depression requested stabilization and assessment with a residential facility in Utah through his HealthNet/MHN HMO.

Residential Therapeutic Care Won Through Ongoing Utilization

MHAIP conducts pre-authorizations and ongoing utilization reviews when clients contact us prior to starting residential treatment

We recently won the 161 days of residential coverage (and ongoing) for a 12 year old girl from Colorado with bipolar disorder and severe anxiety  from United Health Care.

From Sanford Health Plan, we obtained 98 days of RTC coverage for a 15 year old girl with depression and anxiety from South Dakota.

Autism Treatment Won by MHAIP through DMHC

MHAIP won additional hours of 1:1 ABA therapy and reimbursement for out-of-pocket payments for past ABA therapy hours for a family in San Mateo County, CA who have a six-year old boy severely affected with autism.

Click here to read the details and learn more about recent cases we have won.

UPCOMING EVENTS

Tuesday, September 18, 11-12:30

Dr Karen Fessel will be conducting a webinar on “Getting health insurance coverage for those mental health and ASD treatments,” through the Dale Law Firm (http://dalelawfirm.com/)

CONTRIBUTE TO MHAIP

We at the Mental Health and Autism Insurance Project rely on your continued support to provide the following programs to our families:

1)     We provide advice to low-income families on how to appeal denials for autism and mental health interventions.

2)     We monitor legislation and inform policy makers on the needs of our special communities.

3)     We work closely with regulators, bringing systemic gaps and problems to their attention, so that they can enforce the law when health plans fail to follow it.

4)      We educate providers, facilities, and families on how to work with insurance, so that YOU can get your services covered.

Or donate directly through our website.

OTHER WAYS TO SUPPORT MHAIP:

Donate while you shop

(Listed as Autism Health Insurance Project)

click here 

click here

Use either as buyer or seller

Through Employee Giving:

We are a recognized cause through the corporate employer-matching philanthropic site  Benevity (as Mental Health and Autism Insurance Project).

We so appreciate your support!

Thank you for your continued support.

Sincerely,

Karen Fessel

Executive Director & Founder

Mental Health & Autism Insurance Project

Mental Health & Autism Insurance Project | | karen@autismhealthinsurance.org

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Mental Health and Autism Insurance Project

346 Rheem Blvd

Suite 207 D

Moraga CA 94556

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karen@mhautism.org

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