What will it take for insurance companies to recognize autism as a neurological condition?

Question

Insurance companies often treat autism as if it was a psychological condition to avoid paying insurance claims. My daughter needed general anesthesia to have a cavity treated by the dentist. The insurance company denied the claim stating: "General Anesthesia is not a treatment for autism". We appealed the claim and lost... :-(

Answer 1

This is insurance for you. My son had a bunch done a couple of years ago. Of course he gets medicaid so no problem just jumping through hoops. I would get the dentist on your case with the insurance. Find some proof that it is less stressful with the general. I know it is for the person doing the job. That is why they will more than likely be willing to help you. As far as seeing it as a nuerological condition don't hold your breath on that one. They still don't know what causes it, or even why some children with autism can communicate. If you live in a metro or bigger area I would find some local people that have also been through this. Wishing you both best of luck. A....

Answer 2

Sadly, insurance companies are notoriously bad at giving you your money. In theory, you give them a little cash now and then, and they pay for the big things.... In practice, you give them a lot of cash every month, or the police arrest you. Isn't America great?

Mental disorders are one of their favorite scams. They are of course right, that autism involves pshychological disorders, and that anaesthesia is not a treatment for autism... but it's damn hard for a neurological condition to not cause psychological disorders, and doing much anything unusual with an autistic person often would require anaesthesia.

You might consider taking your daughter down to the insurance agency, so they can better understand your situation... since autistics are notorious for thowing tantrums, and the last thing an insurance agent wants is a tantrum in their office, a display of her condition might help to persuade them to see your point of view.

Alternately, you might argue that the cavity is indeed a valid claim, and since your daughter is autistic, the dentist refused to treat her until she had been anaesthetized. Therefore, to get the treatment she needed, it was necessary to provide the anasthesia...

It also might simply be that you've filled out the forms in a way that suggests you are TRYING to treat her autism with anasthesia.

Personally, I suspect that asking legitimate questions of your insurer in a reasoned tone of voice WHILE your daughter throws a tantrum in their office may be the easiest way to get the support you are looking for... if they can in fact provide your needs in the first place.

Admittedly, it sounds a bit cruel and calculating to use your daughter's disorder as a bargaining chip in this manner, but after all the time you've had to deal with her, and them, it seems only fair that they attempt to function in her presence for a half hour or so to at least get an idea of what you've been going through... and if they see things differently, it seems they value your money more than you as a customer. After all, many autistics require constant care, and it seems unfair of them to require you to hire a sitter every time you have an issue to speak with them about.

Answer 3

You need to appeal again and get your dentist involved. He needs to send her medical records to your insurance company and you probably need to make a few phone calls as well- it seems they are confusing general dentistry with autism. This is the way insurance companies operate. They're a pain in the butt, but you gotta hassle with them!