take that.

So. This is what has happened.

In September, Dr. MAL came up and put on a workshop to train all of us in EIBI or ABA. Basically she instructed us on what Autism is. What behavioral training is. How to do it and what would be expected of us and of Maddy in this whole process. We watched a video, did some training, and away we went. We knew beforehand that most likely our insurance would not cover this workshop. Typical insurance companies were denying coverage of this and even though she has condensed what used to be a 4 day training session into a matter of 8 or 9 hours, they would most likely not cover this.

We really didn't have any choice in the matter. We could do this and potentially recover our daughter from Autism or watch her slide further and further into her own world and lose our window of opportunity. So we did it.

The bill was sent to insurance and they denied it. Stating: No benefits are provided for this psychiatric service.

Dr. MAL wasn't surprised and nor were we. We had called the insurance company several times BEFORE the workshop asking if this was covered and why not and what could we do to get it covered. They wanted to know her diagnosis. Fine. Dr. MAL gave her an autism diagnosis. And still they insisted that ABA was not a covered service.

So Dr. MAL sent in an appeal. And we waited. And we waited.

Meanwhile, our state is in the process of creating a bill to get insurance companies to pay for ABA. It's in rough form and was approved to go before the state legislature but it wasn't recommended...we're going to fight hard for it but we have no lobbyists and autism treatment is vast and at best, only 47% successful. This might be a long time coming but we will fight for all those families out there who are less fortunate than us.

Then yesterday.

There was a pile of "explanation of benefits" letters waiting in the mail for us. We get alot of them since our insurance company and Medicaid are nice enough to cover Maddy's speech and occupational therapy. I assumed that's what it was.

I was wrong.

There it was. Approval of our appeal and our ABA workshop was paid. In full.

Paid.

I think my hands were trembling when I looked at Justin standing next to me. He wasn't really looking at what I was reading until I said, "no way."

"what?"

"they paid it."

"no way," and he ripped the paper out of my hands to see for himself. Both of us trying desperately to get to the second page for the true explanation of why they had approved the appeal.

The explanation was simple : this claim is being adjusted based on the medical information submitted by the provider.

Did you catch that? the medical information. Not the psychiatric information but the medical information.

Oh...do you say, dear insurance company, that autism is a Medical condition and not a psychological condition???????????

We're shocked. It's not just about the money. We're taking this as a small victory in a huge battle. We can't insight change without support. Sure, the bill was large and we've been fundraising to pay for it and all the other costs that come with a child with autism. But suddenly, it's gone. Paid. Done.

Wow.

This means the next time a family is sitting in Dr. MAL's office and hearing the words "autism" and "early intense behavioral intervention" - they don't need to be quite so scared. They don't need to worry about payment but rather the treatment for their child.

I know that I pick on cancer quite a bit. Sorry for that. It's just the most "popular" medical illness. And while not all cancer treatment is paid in full either and there are steep co-pays and bills, but most families with insurance don't have to face covering all the costs out of their pocket. That is the entire point of having insurance, right? So they can maneuver through this scary process and not be staring at the dollar signs the entire time.

We just took a small step towards that in autism and while ABA is NOT the cure, it is the most successful process at recovering children from autism when it is performed correctly. We (as in the autism community) have miles to go as far as finding cause and proper 100% treatment. But every little step counts.

Every little step counts.