• Fighting the good fight, against corporate greed.

    "I spent the money to get three more hours of speech therapy for my son who has autism, since my insurance company refuses to pay for it. Every little bit counts for him. By the way, screw you Aetna. I'm downgrading my coverage since you just eat my money and deny me coverage for anything useful anyway..."

    Adam, 40, Father
    Chicago, IL

    22nd May 2008 in Education, Health & Medical, Kids & Toys | Discuss (12) |

Comments

  • Aetna is the worst insurance company I have ever had. They deny valid claims, make you jump through hoops, and over all Aetna sucks! To me aetna represents everything that is wrong with the american health care system and I am seriously thinking of leaving my current job just so that I can get better health coverage.

    Posted by: lurker May 23rd, 09:41

  • New York has covered speech, physical and oc for both of my autistic grandsons. No cost to us or our insurance. You should consider a move. We pay a lot in taxes, but the state is awesome for their educational advantages for special needs kids.

    Posted by: Kathy May 23rd, 09:53

  • Your son will thank you one day.

    Posted by: Daysie May 23rd, 11:11

  • Aetna wanted to charge us for mental health claims for my son - BEFORE he was born!

    Posted by: S May 23rd, 15:49

  • Your School District should be covering that for FREE !!!!

    Posted by: Terri May 26th, 19:03

  • Terri,

    Yeah, the school district is providing him some speech therapy. I believe that it's now, um, 15 minutes per week. This is up from 10 minutes per week last year. Clearly he needs, and deserves, more.

    Kathy,

    Illinois, where we live, also has a law that says that insurance companies are required by law to provide up to 40 sessions per year of speech to my child. Unfortunately, due to the concept of ERISA pre-emption (and it's notorious "deemer" clause), Aetna is not required to do this, as my company's insurance plan is partially "self-funded". This means that my insurance company is free to ignore state and local insurance mandates, as it would be "administratively overbearing". Most employees of large companies are in the same position (about 60% of all insured people work for companies that "self-fund" a portion of their insurance, and in this case, the insurance company isn't subject to insurance law). Yes, I know. It's crazy. Trust me - I've been trying to sort this out with lawyers and arbitration for over a year.

    There's a pretty good primer on the whole ERISA nightmare here: http://www.butterflyeffects.com/community/articles_autism-spectrum-disorder-bills-in-the-florida-legislature.aspx

    Posted by: Adam May 27th, 14:00

  • If your son is over the age of 3 and has a Doctors diagnosis of autism. He should be getting speech therapy though the school district. I also live in IL and my nephew gets speech though the school district.

    Posted by: Melissa May 28th, 23:22

  • This is the first story that has warmed my heart and I did not feel compelled to write a bitter response.

    Posted by: Todd Bridges May 29th, 07:39

  • Melissa,

    Yep, as noted above, he does get speech through the school district. I don't have his IEP in front of me, but believe it to be 15 minutes a week. There's no way that it's enough. I don't blame them, I guess. They have ridiculously limited funding, and the reality is that autism is a medical condition and should be covered by insurance as such. The insurance company's standard practice is to push it off on the school system, which can't possibly deal with the ever growing problem.

    Posted by: Adam May 30th, 08:30

  • Your best shot might be to fight to get the IEP modified to what he really needs. If you can get a provider to place in writing what level of therapy is necessary for your child, take that to your next IEP meeting and demand more.

    Posted by: CA MOON Jun 1st, 10:37

  • Hope everything works out for yr family...Yr must be a proud father.

    God Bless You All!!!

    Posted by: marvin Jun 6th, 13:49

  • Aetna does violate alot of its own policies. The reality is they really are not a healthcare company they are an insurance company. Insurance companies dominate all aspects of our lives, home, auto, health, and we can't do a damn thing about it. They make money by selling us a product and then do not pay the claims.

    Posted by: ditto Jun 20th, 06:01

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