Audience Questions and Closing Comments
This chapter presents questions raised by the audience and the responses and interchanges with the presenters. Topics include success rates, funding sources, addressing goals that are educationally vs. medically necessary, as part of the discussion of bri
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Audience Questions and Closing Comments Raymond G. Romanczyk
Audience question read by Raymond G. Romanczyk: This is to all the presenters, “What sort of success rates have you had for your models in achieving insurance reimbursement for your services?”. That’s a pragmatic question. Ronald Leaf: I’m looking at Andy who’s not looking at me, who does our insurance. I think we are really successful. I think most of our kids are funded through insurance. Julie McEachin has done amazing job in insurance. We get funded for insurance, so it’s been, I wouldn’t say easy, but it’s happened. It depends what kind of insurance the parents have. And what state. Like California. Sally Rogers: There are people using ESDM who do get insurance reimbursement. We don’t get insurance reimbursement right now through the hospital because the staffing patterns that we use aren’t medically billable, so we are in the middle of that right now and I’m trying to figure out the solutions to that, but other people are getting reimbursed for ESDM. Mark L. Sundberg: I want to see if I can get my brother to answer. You’re on the spot, or your wife. We are in Midwest and I’d really encourage people to get in touch with Autism Speaks because they really connect to people all over the US and there is just a variety of different reasons why you may or may not get these claims covered. William Ahearn: We don’t do insurance reimbursed work except for in our home-based services. In the state of Massachusetts, we have a very strong division of insurance, which has implemented insurance reform mandate in a way that is working for the practitioners on the ground, which is why the number of behavioral analysts is increasing exponentially in Massachusetts—the greatest number of per capita behavioral analyst in the world. But really, insurance reimbursement is something that is about to become a real challenge if the CPT codes that were developed
R.G. Romanczyk (*) Institute for Child Development, Binghamton University, Vestal Parkway East, Binghamton, NY 13902, USA e-mail: [email protected] © Springer International Publishing Switzerland 2016 R.G. Romanczyk, J. McEachin (eds.), Comprehensive Models of Autism Spectrum Disorder Treatment, DOI 10.1007/978-3-319-40904-7_8
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ABAI which are just an abysmal nightmare because they don’t include supervision and if, by the way, if you are member ABAI, please fill out the practitioner survey that probably hit your email inbox today to let them know that there needs to be supervision codes in there. So I’m not answering the question really. Audience question read by Raymond G. Romanczyk: The next question is similar, “How do you address writing goals in domains that third party payers are less likely to fund because of categorizing the areas as educational versus medical necessity in your models?”. This is a big challenge to the field in terms of educational necessity versus medical necessity. Ronald Leaf: Yes, this is real easy one for me because I’m going to give it to Andy who does it becau
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