Why Are MAPS Doctors So Expensive?

July 19th, 2015

Frequently we are asked: Why are MAPS ( Medical Academy of Pediatric Special Needs) doctors and other autism treating physicians SO EXPENSIVE?

MAPS is the Medical Academy of Pediatrics Special Needs. MAPS Doctors specialize in the medical issues commonly found in individuals with autism, using a Functional Medicine approach. A group similar to MAPS was DAN! (Defeat Autism Now) but they closed in 2011.

This is a frustrating situation. First it is important to understand why this process is expensive for families. There are some reasons that define the pricing differences. Here are a few:

  1. A well baby check up takes a doctor about 5 minutes. Seeing sick typical kids takes about the same time. A Physicians office will bill the insurance company, apply a co-pay if needed, and then is done and moves onto the next patient. This process happens thousands of items a month in many doctors offices and is a procedure they are familiar with in practicing medicine. Pediatricians can bill and see anywhere from 30-60 patients in a single day. These visits are not a huge reimbursement amount. It can be vary from $20-$40 or more depending on the visit and specialization.
  2. For a MAPS doctor or other treating physician, seeing a child affected with autism is more complex and takes a significant amount of time. My appointments with my son’s doctor are anywhere from 1-2 hours. That reduces the number of patients the doctor can see in one day down to 3-4 vs. 30-60. Hence, their large hourly rates and most also do not accept insurance.
  3. There are a lot of parents looking for answers for their child affected by autism where medical testing and treatment is concerned. I also feel these areas are driving pricing up because of the high demand. Because of this high demand, many good doctors have long wait lists because each patient takes a considerable amount of time to see, take a patient history, perform medical testing, research, and provide a treatment path unique to that child.

Now we have identified the problem and addressed why doctors treating autism are more expensive WHAT CAN PARENTS DO TO HELP CONTROL THE COSTS?

Here Are Some Suggestions For You To Consider

  1. Make sure your office visit is properly coded for all the items discussed and treated for your child. For example, if the visit covers 4-6 areas of medical concern, these all need to be coded to increase your chances of receiving the highest possible reimbursement from your health insurance company that can be provided.
  2. Getting a proper referral from a doctor in your network to a specialist outside your network will increase your odds for reimbursement.
  3. Often parents are told “we don’t cover that for Autism.” It is important to read Insurance Coverage for Autism Biomedical Treatments and Traditional Therapies.
  4. What does the American Academy of Pediatrics’ (AAP) Standards of Care cover for autism? Unfortunately for today–very little. Notice that AAP’s clinical reports expire automatically every five years “unless reaffirmed, revised, or retired at or before that time”. In addition, that is why it is important to call and treat the medical symptoms by their name such as “chronic constipation” versus “autism."
  5. Not all health professionals are perfect in their bedside manner, treatment protocol, and experience. That is why it is sincerely recommended you read The Art of Managing Professionals which includes information about parents’ bill of rights and responsibilities.
  6. Be PREPARED. Go to your child’s doctor’s appointment or follow-up conference call with an agenda and stick to it! Often, parents will wander off topic and spend more time on other topics that will cost more than planned. If you create an agenda and stay on task, you can accomplish more in less time.

    This is especially important if both members or one member of a married or divorced couple participate in the phone consultations and/or at the appointment. Meet AHEAD OF TIME to prepare and AGREE to an agenda. It is important both parents work as teammates in the treatment process for their child.

  7. READ about treatments and lab tests, and information you wish to discuss prior to your child’s doctor’s appointments or follow-up conference calls. Use the appointment time to discuss the treatments and review what you know. Try not to use this time to educate your self from the beginning about a treatment concept.

Once you have prepared and are waiting for that upcoming appointment, the questions that usually follow include, “Why are they so expensive?” and “How can I pay for all of this and get the medical treatment my child needs??”

If you cannot afford a MAPS doctor/autism medical specialist due to co-pays or “no-pays” due to health insurance coverage issues, there are some suggested ways for paying for these important services and treatments. There are several ways folks are getting funding for these treatment services.

Here is my list:

  1. There are many things you can do without a MAPS doctor (or before seeing one) that will be covered by insurance, or do not require a doctor.
  2. Community Grants: There are many organizations in the autism community that offer grants and scholarships. You can also do a Google search for medical funding.
  3. Loans. Apply for a loan from your bank. Some banks offer low interest loans for medical care. This varies by bank and requires some research on your own time. Read Who Pays for What?
  4. Pro-bono work. MANY special doctors offer pro-bono services or have labs or suppliers they collaborate with in an effort to help families in need, resulting in free services and products for families in need. Some doctors dedicate a percentage of overall services to providing needed services to low-income families. YOU DON’T KNOW UNTIL YOU ASK IF THEY PROVIDE THIS!  Each office may have different levels for qualifying for assistance. Please remember not all doctors can offer this service to the community. For a general list of doctors, go to the Provider Directory.You can also ask local doctors (who are covered by your insurance company—check ahead) to rewrite all scripts from the DAN! doctor or other specialist (who are not covered by your insurance company) for tests/treatments to help save on costs.
  5. Payment terms. Many doctors will allow you to pay a fixed monthly fee that meets every budget. Organize this arrangement PRIOR to services commencement and obtain a copy in writing (with the arrangement explained in detail) from their office.
  6. Family. It is time to ask family for help. Instead of birthday and holiday gifts, the best gift may be cash to help you with your child’s needs. Better yet, ask for a loan for medical care fees.

These are some suggestions for helping you understand why doctors’ fees are so high and some suggestions on funding the help your child needs. This is not medical advice.

Important Notes

  1. Autism is biomedical in nature and each child deserves proper medical care to address their unique needs. This entire situation of dealing with health insurance coverages and medical costs is a very frustrating process, but well worth the effort. Remember why and for whom, you are doing all of this work!  Help and advice, or just a soothing ear are always available through TACA; contact a TACA parent mentor and connect with other parents going through the same process as you!
  2. There are no guarantees for health insurance reimbursement, but if you get educated and saavy about the process of reimbursements, proper insurance billing coding, good documentation, and get comfortable making frequent calls to your provider, you will be more successful in the process. Read our Insurance Coverage for Autism Biomedical Treatments and Traditional Therapies.
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