The idea for the Mental Health and Autism Insurance Project came about when parents came together and realized that their health plans were providing few, if any, services for our children with ASDs. A non-profit was formed in 2009. Our mission is to assist families with children with autism spectrum disorders (and later other mental health conditions) to obtain medically necessary treatments through their health plans, so that they can ultimately reach their full potential.
We do this by fielding questions from the public, offering seminars to the public, educating legislators and regulators on laws that will protect these populations, and providing direct services to assist families with obtaining single case agreements, writing appeals and requesting regulatory intervention. We also help providers and the facilities that serve them by offering pre and ongoing authorizations, appeal writing, billing (for facilities), collecting unpaid claims, and other services, as needed.
Even before her son was diagnosed, Karen Fessel sought to get the most out of her health insurance benefits.
We do this by fielding questions from the public, offering seminars to the public, educating legislators and regulators on laws that will protect these populations, and providing direct services to assist families with obtaining single case agreements, writing appeals and requesting regulatory intervention. We also help providers and the facilities that serve them by offering pre and ongoing authorizations, appeal writing, billing (for facilities), collecting unpaid claims, and other services, as needed.
Even before her son was diagnosed, Karen Fessel sought to get the most out of her health insurance benefits.
Services
Karen founded the Autism Health Insurance Project after struggling to secure services for her son, who has Asperger's.
She started AHIP to help children on the autism spectrum obtain medically necessary services by supporting families in their journey through the insurance maze.
Later AHIP became MHAIP, and the journey expanded to include those with other mental health conditions.
In addition to serving as the executive director of MHAIP, Karen co-moderates the ASDinsurancehelp and ASDMedi-Cal Yahoo users groups.
She started AHIP to help children on the autism spectrum obtain medically necessary services by supporting families in their journey through the insurance maze.
Later AHIP became MHAIP, and the journey expanded to include those with other mental health conditions.
In addition to serving as the executive director of MHAIP, Karen co-moderates the ASDinsurancehelp and ASDMedi-Cal Yahoo users groups.
We file appeals and grievances on behalf of individuals/families seeking mental health treatments and autism treatments on a sliding scale fee.
We handle regulatory intervention and external reviews with state regulators.
We will draw up and submit claims and medical records, and conduct pre and ongoing authorizations, for all your clients, for a percentage of what we bring in, or for individual clients, at their request.
For ABA and other Providers: We provide advice, webinars, trainings, consultation, and direct appeal services to assist your families with coverage and/or help you recover unpaid claims and appeal denials.
We handle regulatory intervention and external reviews with state regulators.
We will draw up and submit claims and medical records, and conduct pre and ongoing authorizations, for all your clients, for a percentage of what we bring in, or for individual clients, at their request.
For ABA and other Providers: We provide advice, webinars, trainings, consultation, and direct appeal services to assist your families with coverage and/or help you recover unpaid claims and appeal denials.
The health care exchanges typically open in most states in early November and often close in mid-December.
If you have an insurance plan (through an employer or elsewhere) that does not provide the benefits your child needs, this would be the time to purchase a plan on the ACA exchange.
You can purchase a plan on the ACA exchange any time during the year if you have experienced a life-changing event in the past 60 days, which can include a move, job change, or birth or adoption of a child.
All ACA plans must cover habilitative and rehabilitative therapies e.g.
If you have an insurance plan (through an employer or elsewhere) that does not provide the benefits your child needs, this would be the time to purchase a plan on the ACA exchange.
You can purchase a plan on the ACA exchange any time during the year if you have experienced a life-changing event in the past 60 days, which can include a move, job change, or birth or adoption of a child.
All ACA plans must cover habilitative and rehabilitative therapies e.g.
State regulated plans are also known as fully funded or fully insured plans.
If your insurance is state regulated, it generally means that the state has specific laws which govern how health insurance is practiced.
Individual/family plans that you purchase on or off the exchange, and most plans that are offered through small employers (less than 200 employees) are usually state regulated.
If your insurance was issued in a state other than the one in which you live, the laws of that other state likely prevail.
If your insurance is state regulated, it generally means that the state has specific laws which govern how health insurance is practiced.
Individual/family plans that you purchase on or off the exchange, and most plans that are offered through small employers (less than 200 employees) are usually state regulated.
If your insurance was issued in a state other than the one in which you live, the laws of that other state likely prevail.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), is a federal law that was enacted in order to address health insurance practices that unfairly limited coverage for mental illness and substance abuse.
Generally, the law requires that if plans offer mental health benefits, the financial requirements and treatment limitations for mental health or substance use can be no more restrictive than the predominant financial requirements or treatment limitations applied to substantially all medical and surgical benefits covered by the plan and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.
Generally, the law requires that if plans offer mental health benefits, the financial requirements and treatment limitations for mental health or substance use can be no more restrictive than the predominant financial requirements or treatment limitations applied to substantially all medical and surgical benefits covered by the plan and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.
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