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NJ Stakeholders Address Disputes Over Insurance Law

September 19, 2013

ROBBINSVILLE, NJ (September 19, 2013) -- Autism Speaks, Autism New Jersey, health insurers, state officials and other stakeholders held their first meeting to address coverage disputes that have arisen regarding the state's 2009 autism insurance reform law.

The meetings were requested by Assemblyman Gary Schaer, chair of the Assembly Financial Institutions and Insurance Committee, after his commitee heard complaints in March of questionable denials of claims and misunderstandings regarding the law.

Autism New Jersey, Autism Speaks, and attorney Jodi Bouer produced a report following the March hearing that spelled out concerns raised by families and providers regarding coverage. The report served as the basis for the first meeting that occurred on September 16.

Following an overview of challenges experienced by parents and providers, representatives from the state Department of Banking and Insurance addressed the legal requirements in the 2009 law and its responsibility to investigate potential violations. Representatives for the insurance carriers stated their motivation to address individual and systemic challenges.

Followup meetings will address issues such as coding, provider credentialing, network adequacy, claims processing and authorization, and utilization management.

The participants included parents, providers, and representatives of the New Jersey Association of Health Plans, Aetna, AmeriHealth, Horizon, United Healthcare, and the New Jersey Association for Behavior Analysis. Dan Unumb, Esq., executive director of the Autism Speaks Legal Resource Center, represented Autsim Speaks.