[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
CA Cites 3 Insurers Over Improper Speech, OT Denials
November 19, 2013
SACRAMENTO (November 19, 2013) — The California Department of Managed Health Care (DMHC) has ordered three health insurers to stop denying claims filed for speech and occupational therapy for patients with developmental disabilities, including autism. The three insurers were ordered to reimburse the claims and one–Health Net–was also fined $300,000 for repeated violations.
“Medically necessary speech and occupational therapy are basic health care services that health plans must cover,” said DMHC Director Brent Barnhart [left]. “Today’s actions will ensure that members receive the care required by law.”
The orders were issued against Health Net, Anthem Blue Cross and Blue Shield of California for denying coverage of speech and occuaptional therapy claims without determining whether the services were medically necessary. Health Net was additionally fined $300,000 “for repeatedly and unlawfully mischaracterizing requests for services as coverage issues rather than medical necessity issues.”
Anthem Blue Cross
Blue Shield of California
Under California’s Knox-Keene Act, health plans are required to cover basic health care services whenever medically necessary. Consumers have a right to appeal denials with DMHC acting as final arbiter.
In the case of Health Net, the DMHC received 41 complaints regarding denials. The agency referred 36 of the disputed claims to the Independent Medical Review program which concluded that 35 were medically necessary and should have been reimbursed.
Health Net reversed itself on the other five denials and provided coverage, each of which involved patients with autism. The claims had been denied on the basis they were not caused by a “defined disease” or physical cause, they lacked a qualifying diagnosis or because the service was “educational” rather than medical.
“The fact that the Department’s IMR process overturned (Health Net’s) grievance resolution determination in an overwhelming number of these cases is indicative of the fact that (Health Net) failed to adequately consider its enrollees’ grievances,” the DMHC said in its complaint. “(Health Net’s) conduct unnecessarily delayed the authorization for these services by an average of 88.07 days.”
The Autism Community Is Not The Autistic Community
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.