How to Get the Most out of your Private Health Insurance Benefits

Are you able to use your private health insurance to pay for medically necessary autism treatments?  Autism is a neurobiological condition which is often responsive to early speech, occupational and ABA therapies, yet many health insurance companies fail to provide these medically necessary services to their members. 

There is a law on the books, CA AB88, which requires that autism be treated in parity with other medical conditions for those with state regulated insurance, but actually getting insurance to pay for these interventions can be another matter. 

Several recent cases where parents have taken their insurance companies to Independent Medical Review (IMR) have come back in the parents' favor.  Come hear three parents share their experiences and learn how you can better navigate the insurance system so that at least some of the treatments that our autistic children need can be covered by private health insurance.   

The three presenters include:

Karen Fessel, Dr PH
Autism Parent and Advocate

Karen Fessel is the proud parent of a 13 year old son with Asperger's, and a 10 year old typical daughter.  Karen has a Doctorate in Public Health from UC Berkeley.  She has served as a parent advocate on the Autism Advisory Workgroup.  She fields questions on an insurance help website, and serves on the special ed advisory committee of the Lafayette School District.  Karen has filed and won several complaints and IMRs against three different insurance companies. 

Recently, along with two other parents having children with ASD, she founded the ASDinsurancehelp yahoo group for parents needing assistance with insurance issues.  Relevant work experience includes working as a research specialist for the California Center for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) and developing technology assessments and clinical practice guidelines for the Permanente Medical Group and the Permanente Federation.

Feda Almaliti
Autism Parent and Advocate

Feda Almaliti is the proud parent of 3 boys ages 4 through 10. Her youngest son  was diagnosed with autism at 18 months, and since then she has fought tirelessly to get him the help he needs. Recently she fought and won an IMR against kaiser. It is the biggest win in the state of California related to autism:   26 hours of ABA, 2 hours of speech therapy, and 2 hours of occupational therapy, weekly. She and her son were also featured in a news story on ABC news:  http://abclocal.go.com/kgo/story?section=news/health&id=6493262. 

Feda is the founder of the Kaiser Spectrum Kids group http://health.groups.yahoo.com/group/kaiserspectrumkids/, and recently, along with two other ASD parents, co founded the ASD Insurance help users group http://health.groups.yahoo.com/group/ASDInsuranceHelp/  for parents needing assistance with insurance issues. Feda is also the president of the Fremont SEPTA (special education PTA), the only one of its kind in Alameda county. She has sat on numerous commisions and boards related to autism in California. Feda is dedicated to helping other parents because "It is the parents who have helped and supported me in my journey through autism." 

Kristin Jacobson
Autism Parent Advocate Kristin Jacobson co-founded the Bay Area Autism Advocacy group 2 ½ years ago to organize parents to advocate for legislative reform for autism. The group became the advocacy group for Autism Speaks and Kristin now serves as the statewide Advocacy Chair for Autism Speaks, leading the effort to get autism insurance reform passed in the state of California. She helped organize and serves on the Steering Committee of the Alliance of California Autism Organizations, representing more than 35 autism organizations around the state. She is also Chair of the Special Education District Advisory Committee for the Burlingame School District.