Share   Farmington Talcott Plaza 230 Farmington Avenue Farmington, CT 06032 Phone: (860) 674-1824 Fax: (860) 674-1836     info@thetalcottcenter.com         Keeping up with insurance changes 2010 brought many changes and new state mandates that effected insurance coverage for Autism.  At The Talcott Center for Child Development, our focus is to maximize insurance coverage and to educate parents on the ins and outs of insurance coverage.  In the past, we have testified in front of the state insurance commission in order to advocate for Autism coverage. In the past few years, many insurance companies moved to a managed care system that has jeopardized the hard work and efforts the autism community has put in.  The Talcott Center for Child Development continues to work with our clients and with insurance companies in order to maintain quality and consistent coverage for the treatment we provide.  Look to us for all the latest updates and information regarding these topics.      04.24.2012 2012 – Where did the time go?   It seems as if with every passing day, there are new insurance changes that directly impact the coverage that you and your child receives.  While your policy may seem clear, it most likely isn’t.  There are hidden limitations on what diagnosis we can treat, how visits can be used, what treatment codes are reimbursed and what is the financial responsibility of the family.  Below, we are touching on just a few issues that we often experience.    These days, most insurance companies have taken on a company called Orthonet to manage their occupational and physical therapy claims.    What is the role of Orthonet? Each client who has a policy managed by Orthonet requires our clinicians to perform an assessment and submit it to Orthonet for authorization.  Orthonet reviews this evaluation and then determines whether or not services are warranted.  They may authorize 4 visits or 6 visits at a time.  Once those visits are utilized, we have to submit for further treatment sessions.  At that time, Orthonet determines whether or not your child is making adequate gains and will either authorize further services or deny treatment.  So, even though your insurance policy states you are allotted 20 OT visits and 20 PT visits per year, it does not mean that you can actually utilize them.    And then there’s speech therapy…… While speech therapy services are not presently managed by Orthonet, there are  a boatload of exceptions to coverage.  Many insurance plans state you can receive speech services only if you have experienced an illness or injury that has caused a loss in previously acquired language skills.  What does that mean for the child that has not acquired speech?  It often means that you cannot utilize your speech benefits.      At our clinic, we are personally invested in your family and the services they receive.  We don’t outsource our insurance billing and management to outside companies.  We have a phenomenal administrative team dedicated to working with you and your insurance companies.  While we can’t solve every dilemma or provide an answer to every question, we spend countless hours researching coverage, benefits and reimbursement.  Please contact Kim Bengtson, our Administrative Director, with your insurance questions or concerns.    Read about other methods and strategies The Talcott Center for Child Development has implemented in order to make treatment more affordable... 01.25.2010   Insurance 101 Update   As of 01.01.10, SB 301 has taken effect in Connecticut.  Still, questions remain.  Parents and clinicians are looking for clarification as to whether OT, PT and SLP services for Autism are covered by insurance companies under the bill and to what extent.  OT, PT, and SLP services are mentioned quite frequently in the bill however, some insurance companies claim that the bill states that it is limited to covering behavioral health only.   In an effort to clarify some of these issues, we ask that parents and professionals in the Autism community become educated on these topics and form a grass roots effort to get to the bottom of these issues.    We ask that you take a moment, if you haven't already, to read through the bill and it's amendments.  Below are PDF documents of S.B. 301   S.B. 301 2010 S.B. 301   Looking further into the matter...   According to the most recent release from the Federal Government approximately 1out of 110 children receive the diagnosis each year.  Although the severities range greatly, all literature supports early, intensive, and consistent rehabilitation.  The Bill SB 301 was intended to open up the Autism community to much needed therapies.  Among them, Occupational Therapy, Physical Therapy, and Speech Therapy were included.  However, in Connecticut a managed care company, Orthonet, is now managing visits for Aetna, Cigna, and Anthem insurance products.  This external musculoskeletal company is attempting to manage therapy companies that work with children with developmental delays as well.  They are basing their treatment decisions on a musculoskeletal platform, doling out visits in 6-8 clusters with a 45 day time frame.  At this point treatment is terminated if significant functional progress is not met by the Orthonet Utilization review board.    The problem lies in Orthonet’s concept of treatment duration with children with developmental delays.  Clinical evidence supports longer time frames to justify positive functional outcomes, 6-8 month durations are the norm.   The Bill SB 301 sets time frames for utilization and progress reviews to 6 month durations.  The Bill SB 301 sets visit limitations within the 6 month treatment duration, based on treatment progress and medical necessity only.  The Bill SB 301 sets yearly benefit caps to a specific dollar amount based on the child’s age, a plan that makes all the providers more conscientious and vested in the child’s appropriate treatment plan.    We feel Aetna, Cigna, and Anthem are allowing Orthonet to behave irresponsibly, ignoring the intentions of SB 301 and interpreting the language to best support their business plan by limiting treatment, while children of need continue to suffer.  Our plan and what you can do...   For starters, we all need to become more educated in these matters and become pro-active.  We ask that you contact your insurer and ask the tough questions.  Also, take a stand and contact your local and state representatives.    As a company... We have introduced a series alternative programs that will lower the cost of services without compromising quality of care.  Please see our Therapeutic Solutions page for more information.    We have also downsized our operations in order to reduce overhead and lower the cost of service delivery.    In addition we have always performed our clinic construction, marketing, IT, printing, billing and other services in house in order to pass the savings along to our clients.  We feel it is the ONLY way to offer the highest quality services and the most advanced facility possible.  We are proud of our facility and feel the additional investment of time and energy goes a long way.   Links to find representatives in your area:   http://www.cga.ct.gov/asp/menu/CGAFindLeg.asp  - Rep, Senator and Congressman   https://writerep.house.gov/writerep/welcome.shtml  - US house   http://www.senate.gov/general/contact_information/senators_cfm.cfm?State=CT  US Senate