Fwd: FW: Anthem Blue Cross/Blue Shield ordered to pay for autism therapy
Riki Towle
>>> Nina Cruchon 11/29/2007 10:45 AM >>>
FYI
>>> <be...@autismcolorado.org> 11/28/07 7:12 PM >>>
_____
From: Jeff Konrade-Helm [mailto:je...@autismcolorado.org]
Sent: Wednesday, November 28, 2007 6:07 PM
To: je...@autismcolorado.org
Subject: Anthem Blue Cross/Blue Shield ordered to pay for autism therapy
550 S. Wadsworth Blvd., Ste. 100
Lakewood, CO 80226-3116
Phone: (720) 214-0794
Fax: (720) 274-2744
Contacts: Betty Lehman, ASC executive director
Phone: (303) 898-7656
Jill Tappert - jros...@yahoo.com
Media Release
FOR IMMEDIATE RELEASE
Anthem Blue Cross/Blue Shield ordered to pay for autism therapy
Lakewood, CO - November 29, 2007 - A Boulder family won a hard-fought health
insurance arbitration last week requiring Anthem Blue Cross and Blue Shield
to cover more than $110,000 of prior charges for behavioral therapy for
their four-year-old child with autism.
The decision is heralded by autism advocacy groups as a giant step toward
getting insurers to cover this vital treatment, which costs as much as
$60,000 per year and can take a child from requiring life-long intensive
support and dependence toward a path of independence in as little as two
years of therapy.
The parents, Jill and Stephen Tappert, filed for formal arbitration one year
ago on behalf of their daughter, Abby, after more than one year of appeals,
countless phone calls, and numerous letters with reams of attachments had
not yielded results. "I hope other families are encouraged to continue this
advocacy," said Jill Tappert. "That's what this arbitration was about -
advocating for my child and her peers to get treatment critical for them to
lead as healthy and happy lives as possible."
Some of the findings in the decision include:
. Applied Behavior Analysis (ABA) is not "experimental" and, in fact, "is
the standard of care in treating autism;"
. Autism is a "congenital defect" and/or "birth abnormality" and,
therefore, is not subject to certain policy exclusions;
. ABA is within two coverage provisions of the PPO policy; and
. ABA is medically necessary to prevent the self-injurious and aggressive
behavior that this child demonstrated.
Betty Lehman, executive director of the Autism Society of Colorado, said
that while the decision was based primarily on the facts of this particular
case, this case can serve as somewhat of a "blueprint" for other families to
follow in advocating for their own children.
"Legal rulings are used as precedent all the time," Tappert said. "This
ruling gives others one more arrow in their quiver."
"We need everyone to understand that treating individuals with autism helps
both the individual personally and everyone else," Tappert said. "That's
what many insurance companies and legislators seem to be missing - that
people who receive effective treatment are more productive members of
society and are more likely to live independently."
###
Since 1970, ASC has provided leadership as an advocate for those who have
autism and the systems that support them at the local, state and national
levels. Located in the metro Denver area, ASC provides information and
referral services, advances legislation through the Colorado legislature to
increase funding for treatment and support of autism, and heightens
community awareness of the need for supports and services.
ASC's mission is to promote quality of life for people with autism spectrum
disorders and their families. To achieve our mission, we educate, advocate,
collaborate, legislate and develop support programs with community partners.
Our website is www.autismcolorado.org.
_____
:-j
Jeff Konrade-Helm
Programs Director
Autism Society of Colorado
550 S. Wadsworth Blvd. Suite 100
Lakewood, CO 80226-3116
je...@autismcolorado.org
www.autismcolorado.org <http://www.autismcolorado.org/>
720.275.0053_mobile (9a-9p M-F; noon-6p Sa/Su)
720.214.0794x11_office
866.733.0794_toll-free
720.274.2744_fax
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