What i sent to my NYS represenatives and the child and family and autism retention commitees

[Libby LePinnet]

As members of the autism retention committee, I would like to bring to your attention concerns regarding children with autism in NYS.

 

As of April 1st the state has taken over the early intervention program and there have been issues.  Providers have not been paid by private insurance since April.  This is resulting in many providers leaving the system.  This will severely reduce the hours of services your children and other members families receive. 

 

Early Intervention could not exist at all without the committed providers who work hard to provide services each day.  Many qualified therapists with many years of Early Intervention experience have left the program due to the lack of thought put in by the state prior to the changes in April.  The NYS EI system was rushed and we the providers are taking the weight on our shoulders. We have been seeing our families for months without payment, this allows the families to continue receiving services but we remain unpaid.  Many families are not aware of the situation as ethically we cannot bear the thought of these children not receiving services and we take the financial hit.......

 

Because the biggest remaining hurdle in this system is funding through private insurance companies, I am asking you to please help find a way to speed the process of denial or payment of claims by the insurance companies.  It would be great if the fiscal agent could pay us from the escrow account and then the private insurance payment could reimburse the escrow account. This would prevent those providers who have stayed with the program from having to deal with months of delayed payment. As of July 22, 2013 I have not received any of over 3000 dollars since April 2013 that is held up in private insurance..  At this time, we also have no way to handle claims that have been denied.  The interim fiscal agent does not have the resources to help providers determine where the error has occurred.  Because the permanent fiscal agent does not begin their contract until October, providers with significant issues in billing will have no hope at all of payment.  Often, these errors have occurred because of incorrect insurance information entered into the computer system by service coordinators at the county level who collect intake data, or by incorrect codes provided to the insurance companies by the fiscal agent.  There needs to be some remedy for this.  I personally have a conflict of information in the system because one number was entered incorrectly into the computer system by the municipality, I resubmitted my bills but I was not aware of this for months after my initial April submission.  This is the frustrating part; we can’t hurry up the system. I have called many private insurances to see if they have received my April bills and they have not or there has been an error which does not result in a denial (which would allow me to be paid from the escrow account) just gets sent back to interim fiscal agent without my knowledge of an error.

 

Our families need the services but the therapists need to be paid.  Please be aware this effects the families in your district and families all over NYS.

 

Thank you,

Elizabeth LePinnet Kelly, PT, DPT