The long term benefits of insurance appeals; 

In 2005, my daughter Angelina Irene was born. Her name means Little Angel.

As new parents, we were fascinated with everything she did. We spent every moment gazing at her, completely in awe of how tiny her feet were, how blue her eyes were, how curly her hair was.

She was perfect and we wanted to be perfect parents for her.

During her first two years I developed deep concerns. Lina allowed only us to hold her, screamed in crowds and was sensitive to change.

Her pediatricians were not concerned. Lina had learned how to speak much earlier than other children, could make eye contact and met expected developmental milestones.

For our family, everything was not fine. We were unable to take Lina to family gatherings, park playdates or have a birthday party for her because she would become very upset, cling to us and have meltdowns. We often felt like there was something more we should be doing to make things easier for her, but we had no idea what that could be.

When Lina began kindergarten, other people began to notice how difficult it was for her to be in crowds and how sensitive she was to sensory input. Lina was struggling to enter hallways, sit at a desk and to play with other children.

Her kindergarten teacher suggested we see a physical therapist who worked with sensitive children and that we ask our pediatrician for a referral to the Seattle Children’s Autism Center.

Lina was diagnosed with Autism, ADHD and Anxiety Disorder Not Otherwise Specified (NOS) at age 6. The Seattle Children’s Autism Center gave us recommendations for evidence-based treatment.

When I called my insurance company, I was shocked to find out that Lina would be excluded from neurodevelopmental therapies at age 7. This was devastating news. Soon we would not have access to a therapy program that was helping her.

I was very determined to stop the insurance company from discriminating against my child.

I called every advocacy organization, disability rights, news station and attorney that I could find in Washington. Everyone I called referred me to Arzu Forough of Washington Autism Alliance and Advocacy and Eleanor Hamburger of Spoonmore and Yountz.

I emailed Arzu Forough our entire emotional story and was amazed by her knowledge and compassion. Arzu patiently helped me to begin an appeal for physical therapy for my daughter and helped me learn the Individualized Education Plan (IEP) process.

Ele Hamburger, a generous attorney who has dedicated her time to children with autism and developmental disabilities and their familes in Washington struggling with insurance discrimination, won a case against our insurance company.

Together with WAAA, her advocacy on behalf of families like ours has made it possible for families to access evidence-based treatment regardless of financial situation through several insurance companies. For Lina, this advocacy meant the difference between having to choose to pay the Puget Sound Energy electricity bill or take Lina to therapy.

Several months later, physical therapy for Lina was denied due to a misinterpretation of a referral.  I felt fortunate to know the steps to appeal and to have access to the free self-help insurance tools available to WAAA members.  Arzu once again patiently helped me with the process and we won the appeal!

I realized that the insurance process is a lot like the special education IEP process. For our family, insurance challenges will always be present or possible. Knowing how to solve insurance challenges has made me a more effective advocate for Lina. The benefits of knowing how to appeal an insurance denial will span her lifetime and I hope will help create systemic changes in insurance policy.

This year Lina’s brother Devin was also diagnosed with Autism. I feel deeply grateful to WAAA, Arzu and Ele for their work on his behalf and for sharing their extensive knowledge with me. Devin has received an earlier diagnosis, much faster access to evidence-based practice and better school services due to their generosity and expertise.

I want to help other families the way that Arzu and Ele have helped ours. If you are struggling with insurance, please don’t hesitate to contact me! I have been through the process and will help with each step! I can be reached by phone 360-630-7742, or by email trish@washingtonautismadvocacy.org