We the Patients

Parent Turned Patient Advocate For Bilingual Son With Autism – Adam Hassan, NYC

Adam is an 8-year-old boy with an autism disorder. He is growing up bilingual and while his school provides special services for his autism, he needed more speech therapy than they could provide. His mother Luisa, came to us after the additional speech therapy she requested for her son was denied. You might ask why did the insurance plan turn down the request? They stated the school’s services were sufficient. This is a violation of the law, insurance companies can’t use the receipt of autism services in school as a basis for denial.

Luisa advocated for her son, and won.

Luisa knew the law, she cited it and appealed the plan’s decision. She filed a complaint with the New York State Department of Financial Services (DFS), which ordered the plan to resolve the problem. Yet the plan issued another denial, this time based on lack of medical necessity. Luisa was shocked and dismayed, but she didn’t give up. She turned to CHA, where an advocate worked closely with Adam’s doctors to write an appeal to argue that his bilingual speech therapy was medically necessary and denying it was against the law. Together they won.

Luisa was so grateful to get her son the services he needed, she said, “Adam now sees a speech therapist once a week and is progressing beautifully. I hope this will help other parents who are struggling to get their insurance companies to cover much needed therapies for their children.” Sadly, although Adam eventually received the necessary services, he lost a full year of services critical to his cognitive development.