230 Farmington Avenue
Farmington, CT 06032
Keeping up with insurance changes
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.
2012 Ė Where did the
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 isnít. 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.
most insurance companies have taken on a company called Orthonet to manage
their occupational and physical therapy claims.
What is the role of
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 thereís 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 donít 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 canít 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
Read about other methods and strategies The
Talcott Center for Child Development has implemented in order to make
treatment more affordable...
Insurance 101 Update
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
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
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.
S.B. 301 2010
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 Orthonetís 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 childís
age, a plan that makes all the providers more conscientious and
vested in the childís 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...
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...
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.
also downsized our operations in order to reduce overhead and lower
the cost of service delivery.
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.
find representatives in your area:
http://www.cga.ct.gov/asp/menu/CGAFindLeg.asp - Rep, Senator
https://writerep.house.gov/writerep/welcome.shtml - US house