Your ABA Provider vs Your Insurance Company. Who knows better?

Your ABA Provider. Sorry if that was click-baity.

If that’s all you needed to hear then don’t let me keep you. The rest of this article is a rant and maybe something of a call to arms at the end. I’ll decide when I get there. For the time being, the takeaway is to always listen to your provider over your insurance carrier and be ready to fight with them on that.

You’ll have to forgive me; the inspiration for this article is coming from a personal experience, not a professional one. It does come full circle though, so bear with me.

I found out a couple of days ago that my grandmother has the dreaded C floating around in her system. As to what kind, we’re still unsure. Her doctors asked for a battery of tests that would provide some insight into what is afflicting her but her insurance company denied that request.

Excuse me?

Her doctor requested a test that could be used to save her life or at least increase the quality of life left, but her insurance carrier has decided that the test isn’t yet neccessary.

I’m at a loss. Who in the Hell is a claims adjuster to say no over the advice of a doctor? Whoever is on the insurance end is unbearably unqualified to make that decision, yet they hold the power to do so.

So how does this relate to ABA treatments for Autism?

Well obviously the same insurance company that is crippling my grandmother is the same that is required to pay for medical ABA services. Let me share an event I experience nearly once a week…

I sit across the room from one of our BCBA’s. She spends a lot of time speaking with insurance representatives. And I mean a lot. Often, after her long conversations on the phone with these insurance folk, I’ll hear a long “uuunnnnggghhhhh” and look up to see her massaging her temples…

You see, the source of her unending headache comes from a very specific place. The insurance rep that she deals with nearly weekly… let’s call her Karen… is telling her how many hours the insurance company recommends for our learners.

Come again?

Again, who the Hell is an insurance representative to tell us how to treat our clients?

Karen, to her credit, may actually be a BCBA. Karen, however, has never met the learner. Karen doesn’t seem to have any familiarity with the VB-MAPP, our assessment tool which, mind you, is pretty much an industry standard and also the most empirically validated assessment available. Karen doesn’t seem to understand how data collection and analysis works, yet has the nerve to tell us how we should be doing ours. Karen is extremely out of touch with the research and best practices.

Karen is an idiot.

And this should frighten you if you’re a parent of an Autistic child. Why you ask?

Karen is the idiot in charge of determining the level of services your child gets.

And I probably don’t need to say this, but Karen’s concern is not for your family. It’s saving money for the insurance company.

A difference of just a few hours a week your kid does or doesn’t receive for services can have an enormous impact on their long term development. We conducted our own research that found a linear correlation between hours of service and social skills acquired. But don’t take it from us- just ask any service provider, medical profressional, or someone with common sense. It’s a standard accepted across the field, starting with the Lovaas Institute and upheld by the BACB.

So what to do?

Short Term: ask the BCBA working with your kid’s case how best you can help. Sometimes having two people squawking at Karen the idiot is better than one.

Long Term: the ARICA Bill was a huge victory for families of Massachusetts, but it’s not the end of the fight. Insurance companies are continually finding ways to circumvent, obfuscate, and otherwise ignore this bill. As of current, treatment must be “medically neccessary” and the client typically has to be under 21 years of age (insurance companies, acting against scientific consensus, argue that treatment doesn’t work past the age of 21 because apparently you can’t learn past that age… what?). Treatment is also limited to only children with Autism, despite another scientific consensus that ABA is effective for nearly all types mental health afflications.

It’s time to start ringing your senators and local politicians. Find the ones that are personally affected. Let’s close the gap. Medical diagnosis and treatment decisions should not be left to the insurers. We just need them to shut up and cut the check.