About Us

The 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 background

Even 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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Some of our latest news!


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Families Sue United Behavior Health for Failing to cover Medically Necessary Mental Health

Last month, I had the honor to watch a class action lawsuit in US District Court, Northern District of CA, where a group of very committed United Behavioral Health (UBH) members sued UBH for failing to use adequate standards in determining necessity of Residential and Intensive Outpatient Mental Health Therapies (Wit vs UBH and Alexander vs UBH).
Plaintiffs, represented by attorneys from Zuckerman Spaeder and Psych-Appeal, argued that guidelines developed by UBH overemphasize the "why now" factors, (the acute issues that led to an immediate crisis), rather than address the chronic underlying co-morbid mental health issues.   CLICK HERE TO READ  THE ENTIRE ARTICLE  

Back in Treatment--This Time for a Visit

By Debra Nelson

I look out into the audience of 40 people and see a woman quietly crying. She has a box of tissues in her hands. Other people look attentive, bored or exhausted. The teenagers look especially annoyed to be sitting in hard-backed chairs in a school gym at 8:30 am.

My husband and I are sitting on a raised dais between two potted plants at Intermountain Children's Home in Helena, MT answering questions about how we took care of ourselves during the 18 months our son, Asher, was at this residential treatment center (RTC) for emotionally disturbed children.

I try and be hopeful and funny with my remarks. My husband mentions things that I don't remember about Asher's unsafe and provocative behavior. My memory from the beginning of his stay at Intermountain isn't very good. Parents ask us questions about how we prepared for Asher's return home. One parent says how scared she is to have her child come home. She doesn't feel ready. I tell her that I felt the same way.

 

California Department of Managed Health Care (DMHC) issued a $5 million enforceent action against Anthem Blue Cross of California

Anthem Blue Cross has demonstrated a pattern and practice of failing to identify, timely process and resolve enrollees' grievances. This along with failing to provide the DMHC with timely or complete information has landed Anthem with a $5 million dollar enforcment action.  "The plan must correct the deficiencies in their grievance and appeals system and comply with the law" noted DMHC Director Shelley Rouillard.
The enforcement action is the result of deficiencies of service identified in DMHC surveys, as well as via complaints filed with the DMHC help center during a period from 2013 to 2016. Some of these reported grievances came through MHAIP.

Cases We Have Won (This is a partial list of recent victories)

MHAIP obtained coverage for 50 days of care at a residential treatment center for a young man from New York. MHAIP helped the family of a 22-year-old man with depression and substance addictions obtain coverage for 50 days of residential mental health treatment. MHAIP helped a 17-year-old girl in Illinois receive coverage for nearly one year of residential mental health treatment. MHAIP represented a 17-year-old girl who received long-term care at a residential treatment center after suffering from depression, anxiety, PTSD, and substance addictions that led to many dangerous behaviors. Many more..... 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.

OTHER WAYS TO SUPPORT MHAIP

CA state employees may donate here through the CA state campaign, or with our code 29208. We are also a recognized cause through the corporate employer-matching philanthropic site Benevity (as Mental Health and Autism Insurance Project).

AMAZON: When you shop on Smile.Amazon.com, you can select our organization to receive a small percentage of the purchase price by using this link. All donations made to MHAIP are tax-deductible. We appreciate your support!

EBAY: Support us through the EBAY Charities Program-click here for more details

 

We so appreciate your support!

Wishing you a Happy Spring!

Sincerely,

Karen Fessel

Executive Director & Founder Mental Health & Autism Insurance Project

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