PREVIEW: Treatment Denied

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When you have insurance, you expect it to cover all kinds of condtions. 

South Dakota parents of children with autism believed a therapy that was helping their child was covered by law. But it turns out that isn’t the case. 

KELOLAND’s Angela Kennecke previews a story she’s been working on for Monday’s Eye On KELOLAND. 

Angela Kennecke: A lot of us count on our insurance to cover ongoing treatment. Now imagine if a treatment was covered and then suddenly it was taken away — a treatment you believed was protected by law. 

That’s what happened with this group of mothers of children with autism. They were all getting Applied Behavior Analysis, which is intensive therapy, up to 40 hours a week. It’s been proven that getting ABA before the age of five can make a major difference in learning abilities and behavior of children with autism.

That’s why the South Dakota legislature mandated that insurance companies cover it.  And most of these moms say their claims for ABA were being paid, until insurers discovered they didn’t have to cover all policy holders under that law. 

“We really didn’t offer coverage, we made a mistake and paid a half a dozen claims that shouldn’t have been paid,” Sanford Health Plan President Kirk Zimmer said. 

“No right to appeal, just not covered. So I was shocked,” mother Lindsey Janklow said.  

Angela Kennecke: Coming up Monday on “Treatment for Autism” denied, we take a closer look at how the therapy works. 

We also find out what can be done to help these families who say they can’t afford the treatment out of pocket, but say not getting it could be devastating for their children in the long run. 

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