Tag Archives: Behavioral Health

Question?: Schizophrenia In Children

Richard asks…

How can someone with Schizophrenia take care of two small children?

My daughter-in-law does not want to be home alone with the children (2 and 6) She also does not want to go anywheres, besides being home. She has trouble concentrating on things when you are speaking to her.

admin answers:

As someone who works in behavioral health and has mental illness, I’d say it’s possible, if the person is very faithful with their medications and other treatment he or she may be receiving (and that’s a big if). However, she may need a lot of help and support.

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Question?: Treatment For Autism 2012

Ken asks…

Questions about autism.?

Is it hard to get insurance benefit for a child with autism?
What benefits do insurance cover for children wit autism or other disabilities?
What do they not cover that makes insuring children with disabilities harder and more stressful?

admin answers:

Some states require insurers to provide coverage for the treatment of autism. However, opponents to this approach argue that care for individuals with autism is the responsibility of parents and/or the responsibility of school systems. 2012 Ala. Act, Act 298 requires a health benefit plan to offer coverage for the screening, diagnosis, and treatment of autism spectrum disorders for an insured child who is nine years of age or under in policies and contracts issues or delivered to employers with at least 51 employees for at least 50 percent of its working days during the preceding calendar year. Treatment is defined as treatment that is prescribed by the child’s treating physician or psychologist in accordance with a treatment plan and may include behavioral health treatment (including applied behavior analysis), pharmacy care, psychiatric care, psychological care, and therapeutic care. The coverage required may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the limits or deductibles that apply to illness generally under the health insurance plan, except for coverage for behavioral therapy which is subject to a $36,000 maximum benefit per year. (2012 SB 283)

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Question?: Schizophrenia Test

Thomas asks…

Is there a blood test to diagnosis schizophrenia?

I was diagnosised with schizophrenia and would like to know if there is a blood test I can take to see if I actually have schizophrenia. When I was admitted into the hospital I was give a blood test related to schizophrenia, but I don’t think this was a test to diagnosis schizophrenia. Are there blood test currently available for schizophrenia? Will there be blood test in the future?

admin answers:

As “CB” stated, no there are no blood test to diagnose schizophrenia. The reason you were given the test was to yes rule out any underlying factors that may be causing your symptoms. There is, however, PET scans (http://www.humanillnesses.com/Behavioral-Health-Ob-Sea/Schizophrenia.html & http://www.schizophrenia.com/szbrainimage.htm), however, this test is usually only performed for research purposes, not diagnosing. It is also not 100?% accurate…people w/the diagnosis of schizophrenia do not always changes in brain structures (I’m not sure if there is a vice versa with this.) As with many mental illnesses, what diagnosing schizophrenia comes down to is process of elimination and an educated guess.

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Autism and Insurance: Is the law on your side?

Yes, it is! But few parents know this. Autism Advocate Feda Almaliti explains:

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Many families are coping with autism these days. Consider the statistics; one in every 88 children is diagnosed with autism spectrum disorder (ASD). Even more startling, one in every 54 boys has autism. There is a child born every eight seconds in the United States, and according to the US Census Bureau, more of those births will be boys than girls.

“Early intervention is critical,” parents of children with autism are told, “Get intensive therapy as soon as possible! Do you want your child to be able to talk? Use the bathroom? Live independently? Get that therapy… 25, 30, even 40 hours a week.”

But therapy for children with autism is a financial hot potato. Insurance companies have refused to pay for it. Social services agencies play hide-the-pea with confused parents until their children age out of eligibility (which is easy, since it happens at age 3, the average age of diagnosis). School districts then expertly pick up where the agencies leave off, ensuring that only the most determined and litigious parents receive some portion of the therapy their doctors are recommending.

Autism parents are exhausted (mentally, financially and emotionally) by the time their children are six years old. But the marathon isn’t even at the halfway point by then.

In California and around the nation, a massive fight began to change this pattern. Last year, SB 946 (the Autism Health Insurance Mandate Bill) authored by California State Senate President pro Tempore Darrell Steinberg, was signed into law. It takes effect July 1, 2012.

This law states that California’s state regulated health care plans (also known as fully funded or fully insured plans) that provide hospital, medical, or surgical coverage must also provide coverage for “medically necessary” behavioral health treatment for pervasive developmental disorder or autism.

The behavioral health treatment covered by SB946 includes applied behavior analysis (ABA) and other evidence-based behavior intervention programs.

Ring it from a bell tower. Shout it from the rooftops. This is a big deal!

Parents of children with autism who have fully funded insurance now have hope. Autism therapy should be covered through their plan. Regional Centers, the California agencies responsible for serving residents with developmental disabilities, can and should be responsible for the co-payment.

But for parents, getting insurance coverage for this therapy will still be a challenge. It is never easy to get coverage for expensive treatment. This new law paves the way; it doesn’t guarantee easy access.

So it is time to saddle up. The law is on your side. But you need to be prepared to match opposition with persistence, refusal with resubmission, and to be your child’s personal cowboy. Step up.

Insurance companies have perfected some quietly time-tested methods. They know that if virtually 100% of their subscribers whose children receive an ASD diagnosis come to them requesting therapy. if they refuse them all, only about 10% will come back and challenge that refusal.

The rest will go away.

Be the 10%! You will navigate the refusals, the requests for further information, the redirection and the misdirection. You will not be alone as you make this journey.

For specific information on how to begin the process of requesting insurance coverage for autism therapy (and a peek at the obstacles you are likely to encounter) attend an upcoming insurance lecture in your area or visit Check out www.autismhealthinsurance.org or www.autismvotes.org better yet talk to other fellow parents., join an insurance users group Kaiser Members & All other Health Plans

One caveat – this law does not apply to health care plans that do not deliver mental health or behavioral health services to enrollees, or to participants in the Medi-Cal program. While the Healthy Families Program and California Public Employees Retirement System (CalPERS) are explicitly excluded from the law, they are not exempt from the existing Mental Health Parity law (AB 88).

According to a recently published survey by the Autism Society of California, when families were asked,  “Do you plan on accessing benefits through the new autism health care law? “ almost half (44%) answered, “What health care law?”

Now you know! Let’s ride!

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Feda Almaliti, mother of 3, autism parent and health advocate. Feda is one of the foremost authorities on autism and health insurance coverage in California; she was instrumental in the passage of SB 946.

Currently is a trustee on the state Advisory Commission on Special Education, the Insurance Sub-group Co-chair on Bay Area Autism Regional Task-force (BAART) and is also the founder of the Fremont Special Ed pta (SEPTA).

She and her son have also been featured in numerous news stories, most notably ABC and CBS news.

Feda can be contacted at feda@autismadvocates.com

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Got  questions? Need resources? Email me here citybights@sfgate.com and I will do my very best to help.

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FOLLOW ME on FACEBOOK and TWITTER and read the first three chapters of A REGULAR GUY:GROWING UP WITH AUTISM HERE.

View the original article here

Autism and Health Insurance Workshops: your questions answered

Speaking of autism and health insurance:

If you would like to learn more about your children’s rights and how to maximize your insurance coverage, you won’t want to miss one of the following workshops:

Thursday, June 21st at 6:30 pm

Where: Lafayette Library and Learning Center

3491 Mt Diablo Blvd, Lafayette, CA.

925-385-2280

Special education advocate, Bonnie Yates will join FirstSteps for Kids and will cover the current and future status of insurance funding.

CLICK HERE for more information.

ALSO:

Tuesday, JUNE 26,  6PM TO 8PM

Where: RCEB Office, 500 Davis Street, San Leandro, CA.

Feda Alaliti and Karen Fessel will answer your questions about autism and health insurance. With the recent passage of SB 946 and the current insurance settlement agreements, more parents are accessing insurance coverage for their children’s treatment for ASD.

Feda Almaliti is the Executive Director of Autism Health Advocates.  Dr. Karen Fessel is the founder and Executive Director of the Austism Insurance Project.  Both speakers bring firsthand experience to the challenges faced by other parents with children with autism in regards to the complexities of obtaining services through various insurance companies. Ms. Almaliti  and Dr. Fessel were instrumental in the passage of SB 946 – CA Autism Insurance Mandate.

Sponsored by The Regional Center East Bay and Family Resource Network.

Trumpet Behavioral Health is also providing workshops as well. Click HERE to learn more.

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Got  questions? Need resources? Email me here citybights@sfgate.com and I will do my very best to help.

***

FOLLOW ME on FACEBOOK and TWITTER and read the first three chapters of A REGULAR GUY:GROWING UP WITH AUTISM HERE.

View the original article here