At WAAA we are very enthusiastic about appealing insurance denials. So much so, I’ve been told our enthusiasm is contagious so look out-you might develop an insatiable craving for research and insurance justice by associating with us. Some of us are also a bit dramatic. Not me
though-of course not (how dare you think that?!).
The last couple of months we’ve seen an increase in denials based on ABA being delivered in the school setting. It started on cold, stormy morning, with the wind rattling the lone bush outside the office window (at least I think it did-it was more than a week ago, okay? No one who's had
kids can remember that long ago). It started as it always does with the loud chirp of a phone call. The super-mom on the other end told me Kaiser had denied her child’s therapy. I started tapping away into the magic machine of knowledge (also known as google) to investigate the clinical policy. I found it-in black and white. Kaiser was excluding ABA in the school setting for
children over six-those monsters (nope, not dramatic).
The calls kept coming, insurance companies were doing what they often do-creating loopholes. I suspect they, the insurance underwriters and medical directors, work late nights, somewhere cold and damp, with a flickering light dangling above them, scheming while they twirl their nefarious mustaches. Luckily, we work later nights and get up early in the morning. Yep, you guessed it most of us have kids. (I know what you’re thinking, Why are they in an old-style integration room? Why are their mustaches nefarious? Who knows, you’ve called their customer services, nothing they do makes sense). So, you know, this means it was a trend, and it was spreading.
Kaiser, then Optum, who knows which was next-Premera? God forbid. We had to stop this. It was time for the WAAA Insurance Discrimination Justice League to Activate! And Activate we did (see no drama here).
The League of Incredible Insurance Nerds met in the hallway, near the fax machine that works when it wants to (which is never). Denying services based on the location/facility is a violation of both the Federal and Washington Mental Health Parity Laws so the League of Incredible Insurance Nerds was quickly incensed and ready for action. Mimi the office super dog roamed at our feet sniffing for leads or perhaps treats.
Appeals, we decided that was the ticket (contain your shock and awe-it’s not like that’s what we do here or anything). And appeal we did, using those late nights and enthusiasm (and caffeine-so much caffeine) to write extensive arguments that all boil down to you’re wrong so knock it off you big bullies but in fancy l'eagle (legal eagle) speak. Kaw Kaw! Suddenly, Kaiser changed their policy to stop denying ABA provided in the school setting. I guess they heard the League was on the case. Now we’re appealing to Optum/United Health Care. The League never sleeps (seriously we want to but we can’t, we have kids).
To be continued…
