We are excited to be a part of several employer based fundraising programs this year. Through these programs, you can donate to our organization easily through payroll deductions set up with your employer. This year, we are participating in the Norcal Combined Federal Campaign. From now until December 15, 2016, federal employees can donate to MHAIP by visiting www.norcalcfc.org and search for “Autism Health Insurance Project” or with the 5-digit Code 88784. 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). We are a write in charity (as Autism Health Insurance Project) through the United Way of the Bay Area. In addition, when you shop on Amazon.com, you can select our organization to receive a small percentage of the purchase price by using this link. You can also always donate through our website. All donations made to MHAIP are tax-deductible and help us continue our mission to support families obtain medically necessary treatments through insurance. We appreciate your support!
According to the results of the 2016 Autism Society of California Survey, more children are applying for and receiving covered ABA therapy. In 2012, California passed an autism mandate requiring health plans to provide behavioral health treatment for those with private, state regulated insurance. In late 2014, MediCal became obligated to provide this treatment as well. In 2016, 70% of non-Regional Center families with ASDs were pursuing behvaioral health therapy through thteir insurance as compared to only 38% in 2014. Additionally, in 2016, 73% of respondents reported success with getting approvals for BHT as opposed to only 62% in 2014. Finally, in 2016, 26% of respondents reported discontinuing BHT services because they did not like the providers the insurance company required them to use. This is up from only 8% in 2014.
In recent weeks, our organization has handled several cases in which Anthem has wrongfully denied ABA therapy to children that were previously receiving ABA therapy authorized under their Anthem plans. In each of these cases, Anthem reduced (without warning) the amount of authorized ABA therapy for the autistic child based upon an alleged lack of medical necessity. Each denial letter was substantially the same, stating, in general that the insured child had received ABA for a period of time, had “made reasonable progress” and was no longer in need of the previously authorized amount of ABA therapy. IThe fact that we had four denials from Anthem for children at different functional levels and ages, all citing roughly the same reason for the reduction in ABA therapy, raised our concern that these denials were not based on medical necessity and were simply a pattern of misbehavior by Anthem.
To date, two of these cases have been successfull overturned in independent medical review with the California Department of Managed Care (DMHC), and two are currently in process. In all of our cases, ABA therapy was medically necessary in order for these children to function in daily life.
Please let us know if you have a child's ABA services are significantly cut back. The DMHC is currently investigating further action.