There are still many unanswered questions about what causes autism, and the best ways to treat it. So, when parents find a therapy that works for their child with autism, most will do whatever it takes to make sure they can provide it. Many families have told us that insurance companies repeatedly deny their claims and refuse to pay for certain treatments.
Attorney Mary Sue Anderson's son has autism. "If I were not a lawyer, my son would not be getting a quarter of the treatments he is currently getting."
She is using her personal experience to help other families maneuver through the court system and appeal insurance companies’ decisions to deny coverage claims. "Keep demanding that your child get other treatments or other evaluations," says Anderson.
Attorney Dale Eaton works with Mary Sue and also has a child with Autism. He says for many families’, health problems and the legal issues can continue for many years.
"Our child was turned down as being disabled. We had to go and hire an expert to verify that, which we fortunately knew how to do and it was a pretty quick appeal process, but another person, that could have been a several year odyssey," says Eaton.
Eaton says his search for treatment for his 11-year-old daughter has sent them to medical schools around the country spending hundreds of thousands of dollars. "Then, the quagmire of dealing with insurance to get that approved, I've mastered the appeal for my own child and I don't know how an average person would have accomplished that."
Both Eaton and Anderson say dealing with insurance companies can be difficult.
"I've had to do dozens of insurance appeals following the same model for clients. I can't speak for the entire insurance industry, but some companies have a policy of turning down the first claim," adds Eaton.
However, both lawyers say it is possible for families to win cases against their insurance companies, but they need support from other families and documentation from a trusted medical professional.
"Parents really need to talk to other parents about ‘how do I do this’, ‘where do I start’, and they need emotional support too," adds Anderson.
Eaton suggests families find a good health care advocate. "A good provider knows a lot about insurance and understands the necessity of a referral letter; something more specialized than the medical records. That can go along way. If that doesn't work, then it's time to get legal council."