Families in the autism community face many hardships, including financial ones. The costs of educational, medical and psychological interventions are high. Families who try to obtain reimbursement for their autism-related therapy and medical costs from their health insurance carriers face enormous challenges. States have widely differing laws which may or may not compel insurance coverage for such therapies and interventions. Whether coverage is compelled by statute or not, many insurers attempt to preserve their assets and deny coverage for the most standard treatment protocols for autism, such as Applied Behavior Analysis (ABA therapy). Because early intervention in autism has been shown to be most effective in improving the prognosis for children with autism, families often urgently try to complete as much of the basic medical and therapeutic interventions as possible in as short a time as possible, such as – ABA, speech, occupational therapy, physical therapy. Access to reimbursement from private insurance coverage for these therapies, in addition to or as a supplement to school district reimbursement often becomes a critical concern, as the costs for such intensive therapies can be extremely costly.
The training session at the EBCALA conference on insurance law and autism focuses on the most important things that lawyers and advocates must do to ensure the highest possible level of insurance coverage reimbursement. Attorney Jodi Bouer explains how families and advocates can greatly supplement their child’s educational interventions with therapies covered by health insurance policies. She explains how to present claims and respond to insurer queries to maximize reimbursements and ensure that claims are properly processed and paid. Bouer provides an overview on how to navigate the internal appeal process and how to most effectively use legal leverage when coverage is denied. She will also discuss how Federal Law under ERISA and the Federal Mental Health Parity Act can be used to compel coverage for autism-related therapies and medical interventions.
Bouer is the principal in her own practice that focuses on helping individuals and providers obtain reimbursement for mental health and medical interventions. She has been successful in helping ASD individuals and their providers obtain insurance reimbursement for autism-related therapies under various state and self-funded insurance plans. A large portion of her practice involves advocating on behalf of this community. Bouer has extensive insurance law experience as former counsel at an insurance company and at major law firms. She has taught insurance law at Seton Hall Law School. Her firm helps clients prepare and submit claims and appeals, negotiate settlements, and obtain court orders requiring insurers to honor their coverage obligations.