About UsThe idea for the Mental Health and Autism Insurance Project came about when parents came together and realized that their health plans were providing few, if any, services for our children with ASDs. A non-profit was formed in 2009. Our mission is to assist families with children with autism spectrum disorders (and later other mental health conditions) to obtain medically necessary treatments through their health plans, so that they can ultimately reach their full potential. We do this by fielding questions from the public, offering seminars to the public, educating legislators and regulators on laws that will protect these populations, and providing direct services to assist families with obtaining single case agreements, writing appeals and requesting regulatory intervention. We also help providers and the facilities that serve them by offering pre and ongoing authorizations, appeal writing, billing (for facilities), collecting unpaid claims, and other services, as needed.
Some backgroundEven before her son was diagnosed, Karen Fessel sought to get the most out of her health insurance benefits. Having a Doctorate in Public Health and having worked in a variety of health settings, including Kaiser, she felt that it was important for health insurance to provide medical care that individuals need. When her son first came to medical attention, Karen was told to take him to the school district for further evaluation. Her son was offered a half hour a week of group speech therapy during his pre-school years. He did not qualify for regional center. With only a vague diagnosis of expressive and receptive language delay, Karen turned to her health plan to supplement the school district’s meager offering and also to provide occupational and later group social skills therapies. Later, with the diagnosis of Asperger’s, Karen was able to secure regional center support, more extensive educational programs from the school district, and health insurance protection under AB 88, the California Mental Health Parity law.
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Profile: Attorney General Eric Schneiderman of New York
New York Attorney General Eric Schneiderman has been at the forefront of enforcing state and federal mental health parity laws and advocating for consumers seeking mental health and substance abuse treatment. The state of New York passed a mental health parity law in 2006, called “Timothy’s Law,” prior to the federal Mental Health Parity and Addiction Act, passed in 2008 by the Obama administration. These laws seek to ensure that mental health and addiction are treated by health plans the same as physical illness. They require behavioral health coverage be no more restrictive than medical coverage in terms of financial requirements (co-pays, deductibles, etc.) or limitations on the number or frequency of visits to a provider.
While the new laws were welcomed by health care advocates and consumers, many health plans continued to deny or delay treatment for mental health and addiction. In this climate, Attorney General Eric Schneiderman, who first assumed office in 2011, worked to enforce mental health parity laws and compel health insurance companies to provide coverage for consumers. His office provides a toll-free Health Care Bureau Helpline for consumers to learn about their rights, make a complaint about their insurer and get access to the health care they are entitled to. The Bureau investigates insurers and providers, sometimes based on complaints from consumers, that ignore or fail to comply with the law. His office reached settlements, including levying hefty fines, with major insurers that failed to meet the behavioral health needs of their members.
We submitted the following questions to the Attorney General's office to gain insight into the approach his office has taken to help consumers, advocate for the law and hold insurance companies accountable.
First Steps: Getting ABA for Your Child
You can be your child’s advocate and secure ABA treatment through your health plan. Insurance coverage of autism treatment and services is required by law in 46 states and the District of Columbia, including ABA. To secure this medically-necessary treatment for your child, follow the steps below:Understand Your Health Plan - Fully-Funded or Self-Funded?
Determine if your plan is regulated by the state, referred to as fully-funded, or subject to federal regulation, a self-funded plan. If you are uncertain about whether you have a state regulated plan, check with your human resources department or the administrator of the plan.
Fully Funded: The laws vary slightly from state to state but if your plan is regulated by your state, there is an appeals process and other supports in place that ensure that plans meet their obligations under the law.
Self-Funded: These plans are exempt from state regulation. While there are fewer protections for consumers, many self-funded plans do cover autism treatments like ABA. Read through your Plan Description or contact the insurer to determine whether autism treatment is covered.
If your plan doesn’t explicitly exclude autism treatment, it is worth going through the authorization process (see the following section) to determine whether you can get coverage.Click here to learn more about securing ABA through your health plan
Cases We Have Won (partial list of recent victories)
Pre-authorizations: MHAIP does pre-authorizations for families that contact us before their children start residential treatment or very early in their stays. We recently won several cases, all through United Health Care, at the residential level of care. MHAIP recovered over 36K from Horizon Blue Cross Blue Shield for a seven week stay at a Wilderness program for an 18 year-old New Jersey youth with depression and substance abuse issues. MHAIP helped a young man from New York with substance addictions get coverage for an additional 51 days of mental health residential treatment. MHAIP helped a family partially overturn a reduction of ABA hours Click here to read the details on these cases
SUPPORT MHAIP to Help Families!Your donation helps us to field calls from the community and provide advice to low income families. Donate through through the Pay Pal link below or on our website.
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