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Sunday, June 24, 2012

A Legal Struggle for Coverage in New Jersey

The Newark Star-Ledger reports on a New Jersey family that tried to get its insurer to pay for ABA. Despite a state supreme court ruling and a statutory mandate, it was a struggle:
The family spent their savings and mortgaged the house to pay for years of behavioral therapy for their son Matthew, 7, after he was diagnosed with a form of autism as a toddler. And then they shelled out thousands in legal fees in a 3½-year battle to convince the state health benefits plan and insurer Horizon Blue Cross Blue Shield of New Jersey to cover it.
The fight ended last month when the insurer mailed a check for $97,088.45. But the couple says the experience shows how hard it is to get coverage for children with autism and other developmental disabilities — despite the court ruling and a 2010 law mandating it for all state-run and state-licensed insurers. "The problem with insurance companies is they make it so challenging to file claims," said Meredith Blitz-Goldstein, an oral surgeon who works for the state-run New Jersey Dental School. "A lot of parents don’t know how to get through the system, and I think that’s how Horizon likes it."