ABA Therapy

[trickpony1]

So the Teamsters actively look for union members with pre existing conditions to fire?

Who said anything about the Teamsters?
When I was PT my insurance was through the company...not the union.

 

[scooby0048]

True. But what is coverage? She requires 20 hrs a week. Is it only going to cover two hrs and now I'm stuck paying 18 out of of pocket? But your saying well I'm covering you. I'm basing this off what's going on around me with other patients and their insurance companies.

IDK if this helps you or not, but here is an excerpt from the plan document of the Teamcare coverages, Central States, UPS plan U1:

12.09 BEHAVIORAL HEALTH BENEFIT -OUTPATIENT
A Covered Individual may receive from the Plan a Behavioral Health Benefit - Outpatient as follows:
(a) Covered Expenses—
All services rendered on an outpatient basis under the direction of a psychiatrist, Physician,
Clinical Psychologist, or licensed social worker performed for maintenance of a psychiatric
condition or chemical abuse program in affiliation with a Hospital, Psychiatric Treatment
Facility or Alcoholism or Substance Abuse Treatment Facility.
(b) Amount Paid—
The Plan will pay the level of benefits specified under Section 20.01(h) for all covered
outpatient expenses for each Covered Individual.
(c) Non-Covered Expenses—
The Plan will not pay charges for:
(1) Educational, vocational, financial, family or marital counseling;
(2) Legal Services;
(3) Recreational counseling;
(4) Services rendered by a federal, state or other institution for which the member
is not legally required to pay;
(5) Dues or contributions to a supportive organization or facility; and
(6) Services rendered by an individual who is not licensed or not registered in the
state where services are performed.
(7) Regressive therapy, megavitamin therapy, nutritionally based therapies for
chemical dependency treatment, and non-abstinence based chemical
dependency treatment;
(8) Custodial care, including, but not limited to, treatment not expected to reduce
the disability to the extent necessary to enable the patient to function outside a
protected, monitored or controlled environment;
(9) Services and treatment for intellectual disabilities, autism spectrum disorders (ASD) and/or developmental delays except for initial diagnosis. Applied Behavioral Analysis (ABA) may be covered for ASD;

If the ABA is covered, then this is what you can expect if you are part of the Central States plan:

 

[browndevil]

He does have a point, although it is illegal to deny coverage due to preexisting conditions.

"Thanks Obama"

 

[NerdGirl]

IDK if this helps you or not, but here is an excerpt from the plan document of the Teamcare coverages, Central States, UPS plan U1:

12.09 BEHAVIORAL HEALTH BENEFIT -OUTPATIENT
A Covered Individual may receive from the Plan a Behavioral Health Benefit - Outpatient as follows:
(a) Covered Expenses—
All services rendered on an outpatient basis under the direction of a psychiatrist, Physician,
Clinical Psychologist, or licensed social worker performed for maintenance of a psychiatric
condition or chemical abuse program in affiliation with a Hospital, Psychiatric Treatment
Facility or Alcoholism or Substance Abuse Treatment Facility.
(b) Amount Paid—
The Plan will pay the level of benefits specified under Section 20.01(h) for all covered
outpatient expenses for each Covered Individual.
(c) Non-Covered Expenses—
The Plan will not pay charges for:
(1) Educational, vocational, financial, family or marital counseling;
(2) Legal Services;
(3) Recreational counseling;
(4) Services rendered by a federal, state or other institution for which the member
is not legally required to pay;
(5) Dues or contributions to a supportive organization or facility; and
(6) Services rendered by an individual who is not licensed or not registered in the
state where services are performed.
(7) Regressive therapy, megavitamin therapy, nutritionally based therapies for
chemical dependency treatment, and non-abstinence based chemical
dependency treatment;
(8) Custodial care, including, but not limited to, treatment not expected to reduce
the disability to the extent necessary to enable the patient to function outside a
protected, monitored or controlled environment;
(9) Services and treatment for intellectual disabilities, autism spectrum disorders (ASD) and/or developmental delays except for initial diagnosis. Applied Behavioral Analysis (ABA) may be covered for ASD;

If the ABA is covered, then this is what you can expect if you are part of the Central States plan:

View attachment 274342

Thank you!!!!!!!

 

[scooby0048]

Thank you!!!!!!!

Your welcome. There are still some variables here though. For the coverage, certain things are only covered at somewhere around 85% and then you would be responsible for the balance. This (if covered which I think is) should only cost you the deductible. In other words, when I go see my regular doctor for anything at all, I pay $10 no more, unless something else comes up.

I had to undergo therapeutic phlebotomy that would have cost $130. I will probably have to pay $23 or so out of pocket because I have not met my individual yearly amount of $1000 per person and $2000 per family and the therapeutic phlebotomy is not covered for that particular instance.(It was considered out of network since I had to go to an independent lab)

By the way, where is the picture in your avatar taken?

 

[NerdGirl]

Your welcome. There are still some variables here though. For the coverage, certain things are only covered at somewhere around 85% and then you would be responsible for the balance. This (if covered which I think is) should only cost you the deductible. In other words, when I go see my regular doctor for anything at all, I pay $10 no more, unless something else comes up.

I had to undergo therapeutic phlebotomy that would have cost $130. I will probably have to pay $23 or so out of pocket because I have not met my individual yearly amount of $1000 per person and $2000 per family and the therapeutic phlebotomy is not covered for that particular instance.(It was considered out of network since I had to go to an independent lab)

By the way, where is the picture in your avatar taken?

Oy... if it was 10 dollars a session I'll be paying 230 a week...I mean right now I'm covered by Medicaid and pay nothing. I just don't have alot of faith in that staying around forever...but I may have no choice....
From a trip to Cleveland Metro Parks.

 

[scooby0048]

Oy... if it was 10 dollars a session I'll be paying 230 a week...I mean right now I'm covered by Medicaid and pay nothing. I just don't have alot of faith in that staying around forever...but I may have no choice....
From a trip to Cleveland Metro Parks.

Well, don't get discouraged yet. I'm guessing that each session is 2-4hours a pop 5 days a week right? I'm pretty sure the session is covered so even if you had to go twice a day 5 times a week, you would be looking at $100. Once a day for 4 hours is only $50.

The extreme end of it is if the therapy was not covered. Then you would be responsible for the remaining 15% not paid by the plan.

From what I read and then a little further, it seems the ABA is covered fully.

 

[UnconTROLLed]

That's pretty ed up for a union to be doing. And they wonder why they are despised by non union workers. SMH....

This is new to you?

 

[MAKAVELI]

This is new to you?

Not at all. Just interesting to hear union members opinion of this buddy**.