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Denied Insurance Coverage for Autism Spectrum Disorders

Understanding what a health insurance plan does or does not cover can be both confusing and overwhelming. Families affected by Autism Spectrum Disorders face the additional difficulty of insurance companies wrongfully denying coverage for medically necessary treatments.

The California Mental Health Parity Act requires health plans to cover Autism Spectrum Disorders to the same extent that they cover other physical illnesses. The Pasadena and Claremont autism services lawyer at The Law Offices of Scott Glovsky currently works with families to help them obtain coverage for medically necessary treatments from their health plans and health insurance companies.

When a health insurance company denies coverage, it can feel like the company has taken away our ability to recover the one thing we should all be entitled to–our health. We have witnessed how upsetting, intimidating, and dooming a denial from a health insurance company can feel through our clients. The fact of the matter is, denying coverage or treatments is just part of the day-to-day business for health insurance companies.

If you have been denied health insurance coverage or autism treatments including Applied Behavioral Analysis (ABA), speech therapy and occupational therapy in the state of California, contact us today. Scott Glovsky is an experienced personal claims attorney who has extensive experience working with families affected by autism. He is committed to helping you receive the benefits you deserve from your health insurance plan.

Importance of Contacting a Autism Services Attorney

Understanding what is and is not covered under any given health insurance plan can be a confusing and overwhelming process. The California Mental Health Parity Act requires health plans to cover Autism Spectrum Disorders to the same extent that they cover other physical illnesses. Our Pasadena and Claremont autism services lawyers have litigated cases that have benefited thousands.

If you have had health insurance coverage or autism treatments including Applied Behavioral Analysis (ABA), speech therapy and occupational therapy denied in the state of California, contact me today. I am an experienced health insurance coverage attorney who has extensive experience working with families affected by Autism. I am committed to helping you receive the benefits you deserve from your health insurance plan.

If your health insurance company or health plan has refused to provide your child with ABA, speech therapy and/or occupational therapy, please contact us.

Common Treatments for Autism Spectrum Disorders

BEHAVIORAL INTERVENTIONS

Behavioral intervention breaks down target behaviors – the behaviors you want a child with autism to master – into very small, separate components. Each skill is taught systematically in a way that is likely to be effective for that child, utilizing specific prompts and reinforcements until the child reaches a predetermined level of mastery that is designed to increase the likelihood that the child will maintain the good behavior and will be able to generalize that behavior to other environments.

PIVOTAL RESPONSE TECHNIQUES

Pivotal response teaching (PRT) is a method that uses naturalistic and motivational procedures to increase appropriate developmental behaviors in children with autism. PRT focuses on fostering communication and play behaviors. Based on ABA principles, PRT focuses four critical or “pivotal” behaviors that affect a very wide range of other behaviors:

  • Being responsive to multiple cues
  • Motivation
  • Self-management
  • Self-initiation

DISCRETE TRIAL TRAINING

Discrete Trial Training (DTT) is a technique used within the realm of Applied Behavior Analysis. “DTT methods are useful in establishing learning readiness by teaching foundation skills such as attention, compliance, imitation and discrimination learning, as well as a variety of other skills.” (Pediatrics, “Management of Children with Autism Spectrum Disorder,” October 29, 2007.) In this approach, a therapist sequentially presents a discriminative stimulus (an instruction) and provides consequences for a correct or incorrect response. DTT is effective because it gives a child a clear message as to what is expected. It also lets the child know if the response is correct and appropriate.

RAPID PROMPTING METHOD

Rapid Prompting Method (“RPM”) is another method for students with autism. RPM uses a “teach-ask” paradigm to elicit responses from the child to intensive verbal, auditory, visual and/or tactile prompts (questions) from the therapist. For example, the therapist will give the child information about a topic and will then immediately ask a question based upon the information provided. An example is that the therapist may say “Dog is spelled D-O-G,” and will then ask the child, “What did I say? Dog is Spelled D-G-O or D-O-G?” Child responses evolve from picking answers written on a piece of paper, to pointing to a correct response, to typing and writing responses. The constant prompting utilized in RPM competes with the autistic child’s self-stimulatory behavior, which helps to keep the child on task and focused.

Behavioral interventions can improve symptoms and behaviors.  They can help with social skills, positive peer interactions, gross and fine motor skills, communication skills, self-esteem, coping skills, movement, and coordination.

Health Insurance Companies We Have Sued for Denying Coverage

The autism services attorneys at our firm work with families affected by Autism Spectrum Disorder to help get them the coverage they deserve. We have been working on behalf of people who have been unfairly denied coverage by their health insurers for over 20 years. We have successfully sued the following large health insurance companies in California:

If you have been denied coverage by any of the above companies, or any other health insurance companies in California, call The Law Offices of Scott Glovsky today.