As most of the nation fixates on the future of health insurance, clinicians and other professionals in the field of autism care continue their ongoing battle to make a case for coverage of treatments like applied behavioral analysis (ABA).
Just recently, Capital Public Radio in Sacramento reported that California patients are facing insurance denials in record numbers — nearly triple. In many of those cases, families are fighting to get coverage for autism treatment. One family was told by their insurance provider that their adult son’s ABA treatment was “not medically necessary based on recent and relevant scientific evidence.”
In response to the challenges, LittleStar ABA Therapy is hosting a one-day workshop to provide clinicians with tips on writing successful treatment plans that support medical necessity for health-insurance funded individuals with autism. These letters of medical necessity (LOMN) are reviewed by insurance companies or governmental agencies in determining whether to approve coverage for treatment.
The workshop, aptly named “Navigating the 10th Circle of Hell: A Roadmap to Writing Medically Necessary Treatment Plans,” is scheduled for 9 a.m.-5 p.m., Jan. 19, 2108, in the Public Forum Room, National Louis University-Lisle Campus, 850 Warrenville Road, Lisle, Ill. The workshop also offers an online option for those unable to attend in person.
The workshop will be led by Tim Courtney, MS, BCBA, the COO for Little Star Center, a non-profit organization based in Indiana.
Courtney is an advocate for the enforcement of insurance mandates, medical necessity documentation and ethical billing. He has a master’s degree in applied behavior analysis from the Florida Institute of Technology (FIT). In addition to earning his certification as a behavior analyst, he has been an instructor in the ABA department of FIT.
The topics covered during the workshop include:
- How to organize all of the steps of a medically necessary treatment plan from pre-authorization through re-authorization.
- How to state the necessary components of a comprehensive and focused treatment plan to meet medical necessity.
- How to review diagnostic reports, behavioral assessments and the written treatment plan to ensure they justify medical necessity.