Thursday, November 29, 2007

Good things come to those who wait....



Wait and fight like hell.

Anthem Ordered To Cover Costs Of Autism Therapy

Family Wins Case In Autism Coverage Lawsuit

Abby Tappert was diagnosed with autism two years ago. At the time, her mother, Jill, said Abby couldn't talk or socialize like other kids.

Like most mothers, Jill Tappert searched for treatment plans -- anything that would help her daughter live as normal a life as possible.

Today, Abby is quite capable of having a conversation at the lunch table.

She even has an extensive dinosaur collection that she loves to line up and name off.

Her mother credits Abby's remarkable progress to a treatment plan called Applied Behavior Analysis or ABA.

The only problem with the plan was it wasn't covered by their insurance company and it wasn't cheap. In fact, two years of treatment cost the family about $110,000.

But, Jill Tappert didn't give up.

She launched appeal after appeal and finally called in a lawyer.

Last week, an arbiter sided with the Tapperts and awarded them $110,000.

It was an important decision for the Tapperts and other families of autistic children across the U.S.

"I do think it sets a precedent for some families, families that have a PPO policy with Anthem including other states. (They) will be able to look at the ruling and go Anthem's policy is flawed. ABA is the standard of care in treating autism," said Tappert.

But, Anthem Blue Cross/Blue Shield said not so fast.

In a statement the company said: "This decision is not a broad-based declaration that ABA therapy is 'medically necessary' in all cases. To what extent this type of therapy should be covered...should be made by legislators and/or the division of insurance."

The ruling's implication is still unknown but the Tapperts said it's a step in the right direction.

Anthem said several insurance companies do not currently provide ABA coverage.

They said if a family would like to make a claim for ABA coverage they will evaluate them on a case-by-case basis.

Family Voices of Colorado helps families with the appeals and filing process. You can contact them at 1-800-881-8272 or via the Web at familyvoicesco.org


I pray that that Blue Cross Blue Shield is the first of many insurance companies who do the right thing. I hope they fall like a house of cards, the shameless miscreants. Can you imagine the outcry if insurance companies denied coverage for chemotherapy to cancer patients because it wasn't "proven" to work in every case? Or anti-depressants for mental illness for the same reason?

Way to go Tappert's! Thank you for fighting the good fight. I pray that your Abby continues to grow, blossom, and reach for the stars.

Everyone else, keep it up. We shall overcome!

The seventy-two returned with joy and said, "Lord, even the demons submit to us in your name."

He replied, "I saw Satan fall like lightning from heaven. I have given you authority to trample on snakes and scorpions and to overcome all the power of the enemy; nothing will harm you. However, do not rejoice that the spirits submit to you, but rejoice that your names are written in heaven."

At that time Jesus, full of joy through the Holy Spirit, said, "I praise you, Father, Lord of heaven and earth, because you have hidden these things from the wise and learned, and revealed them to little children. Yes, Father, for this was your good pleasure.


Luke 10: 17-21

7 Comments:

Blogger Trisha said...

Oh, Susan! I have missed you SO much! I have needed your advice on Ryan's diagnosis. I am so glad to see that you have posted something new. I've been praying for you and those beautiful little girls :)

5:45:00 PM  
Blogger supposedly susan said...

Hey Trisha!

I am so embarrassed about my breakdown that I have not been able to respond at TCO. Bless Kyra, Pea and Kim. Mauri and you too.

I am working up to saying howdy at TCO soon. Will you please convey my message of wellness?

So what is up with Ryan? Was he dx'ed?

7:19:00 PM  
Anonymous Mauri said...

Susan, I am so glad you are ok. I have been so worried about you. We all love you and miss you and eagerly await your visit to TCO.

3:36:00 PM  
Blogger Trisha said...

Oh, Susan. you shouldn't be embarrassed! We were all so incredibly worried about you. I'm just glad that you are ok again :)

Ryan was Dx'ed with PDD, ADD/ADHD, Anxiety, OCD and a couple of other things that I can't think of right now, lol. I guess the PDD Dx was because they couldn't pinpoint it to AS (or some other ASD) and some of the others go hand-in-hand with that.

8:18:00 PM  
Anonymous Janice said...

Hey, friend :) I've tried to send you a couple emails but I guess I don't have your correct email and couldn't find it. Just wanted you to know you've been in my prayers and I'd love to hear from you! Hope all is well with Jimmy and the girls too.

Much love,

Janice

10:02:00 PM  
Blogger Ashley loves Leo said...

Merry Christmas and Happy New Year to you Susan! THanks for all of your posts, they are filled with love, warmth, and excellent info.

Love, Ashley

1:01:00 PM  
Blogger Kelly Family said...

What a great judgement! I hope it does spread to other states and insurance plans...what amazing help that would be. It amazes me how many parents somehow make a way to pay for ABA.


I'm really enjoying reading up on your blog while I sit with my little Abigail...

britt

2:35:00 PM  

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