Can someone help me here?

iVillage Member
Registered: 11-07-2004
Can someone help me here?
2
Fri, 07-07-2006 - 3:40pm
Our pediatrician referred us to a phsychiatrist that specializes in Asperger's/Autsim. I called my mental health plan (EAP) and they do not cover asperger's or autism treatment. I am sure my medical plan isn't going to cover a phsych. as that is why we have a mental plan. Has anyone run into this? Do any of your children see a psychiatrist? And if so, what does he/she do for your child? I mean now that he is diagnosed, who treats him? The EAP said his school does. Well, they can barely provide adequate education much less provide additional treatment.
iVillage Member
Registered: 03-26-2003
Fri, 07-07-2006 - 4:02pm

Hmmmm, I would go through your behavioral health again and try a couple things. I don't always trust what I first hear when I call.

1) just call and ask for a referral. If they ask why, don't give a diagnosis but rather specific behaviors that are concerning and why you want to see a psychiatrist. Play up the bad stuff and anything that sounds mental health-esque. Sorry, but that is the game we have to play sometimes.

2) Reread your benefits and see if it says in there specifically that they don't treat autism. If it does not then another method is to call again, try what you tried before and when they decline based on the ASD diagnosis ask to speak to a supervisor. Tell them you want it in writing that they are refusing treatment and why and ask to appeal it based on x behaviors (again specifics as related to why you need to see a psychiatrist. Anger outbursts, evidence of depression, anything like that)

3) go back to diagnostician and ask if you son fits and they can give a comorbid diagnosis that would fit within the limits of your insurance (ie, ADHD, mood disorder, etc.) Use that dx to get mental health services.

Make sure you read up in your benefits the process for appeal.

Renee

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iVillage Member
Registered: 11-07-2004
Sun, 07-09-2006 - 9:37pm
Thank you very much for your knowlege. There is just so much to learn.