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From: wtm@bunker.uucp (Bill McGarry)
Newsgroups: misc.handicap
Subject: Re: NEED HELP - DISABLED CHILD _ INSURANCE DENYING COVERAGE
Message-ID: <15064@bunker.UUCP>
Date: 19 Oct 90 04:23:42 GMT
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Reply-To: wtm@bunker.uucp (Bill McGarry)
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Index Number: 11194

Ely Feinerman (ely@jpl-devvax.JPL.NASA.GOV) writes:
>I have a 3 Year old Autistic Son.  He has been receiving Intense
>Behaivor Modification Theraphy in my home from a staff of
>specialists.  After an initial fight with the insurance company
>they agrrred to pay for the services.  Now they are turning the
>tables on the payment. . . .

Just a couple thoughts -- First, the disclaimer:  I'm not a lawyer
but between me with my pain problems and my son Alexander with
all sorts of medical problems, I've had more than my share of
fights with insurance companies.

Now some suggestions:

Is this insurance through the company that you work for?  If so,
your first step would be to talk to your Human Relations department.
The contact person in your company will generally be in frequent
contact with the insurance company at the supervisor level.

If this is company insurance, then I believe that you are entitled
by Federal Law to receive a copy of the actual policy, not just the
brochure that is handed out to the employess.  I cannot recall what
the law is called but the company (your company, not the insurance company)
has 30 days to get you a copy (this is the stage that I'm at with
my latest fight).

Then you ask the insurance company to point out in the policy where
it says that they will not pay for these services or you can
search for some loophole.

Every insurance company also has some method whereby you can
officially appeal when they reject your claim.  This should
be listed in your insurance information or in the policy.

I would think that the fact that they have paid for six months
would make it harder for them to now deny future claims.

Many (all?) states have an Insurance inspector or commissioner
whose job is to see that insurance companies do what they're supposed
to.  Contact them.

What is the city's special education department doing with your son?
They must provide him with an "appropriate" education.  (Anyone with
a special ed child soon learns that the magic legal word "appropriate"
covers a enormous range of services.)  If you are not satisfied with
the "appropriate" education that he is receiving, you can request
a re-evaluation of your son.  I've been through this route as well
so if you want, I can expound further, but you should be able to
get the information on requesting a new PPT meeting, appeals, etc
from your special education department.

Last alternative, I guess, would be to hire a lawyer.

Good luck and please keep us advised as to what happens.

				Bill McGarry
				(203) 337-1518

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