Frequently I am asked: Why are DAN! (Defeat Autism Now!) and other autism treating physicians SO EXPENSIVE?
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:
- 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 is done and 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.
- Seeing a child affected with autism for a DAN or other treating physician is more complex and takes a significant amount of time. My appointments with my son’s doctor are anywhere from 1-2 hours. That takes the doctors # patients being seen in one day down to 3-4 vs. 30-60. Hence their large hourly rate and many do not take insurance.
- 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 DO PARENTS DO TO HELP CONTROL THE COSTS?!
Here are some suggestions for you to consider:
a) Make sure your office visit is properly coded for all the items discussed and treated with your child. For example: if the visit cover 4-6 areas of medical concern these need to be coded so the highest possible reimbursement from your health insurance company can be provided. It is important to read this link.
b) Getting a proper referral from a doctor in your network to a specialist outside your network will increase your odds for reimbursement.
c) Often parents are told “we don’t cover that for Autism.” It is also important to read this important California law about “equal parity for insurance coverages”.
d) What does the American Academy Pediatrics Standards of Care cover for autism? Unfortunately today – very little. Read about what they cover by clicking here. (Notice it has not changed in over five years. In addition that is why it is important to call and treat the medical symptoms by their name such as “chronic constipation” versus autism”)
e) Not all resources are perfect in their bed side manner, treatment protocol and experience. That is why it is sincerely recommended you read this article about managing professionals and the parent bill of rights.
f) Be PREPARED. Go to your doctors appointment or follow up conference call with an agenda and stick to it! Often parents will wander off topic and take more time that will cost more than planned. If you create an agenda and stay on task you can accomplish more in less time.
This area requires an important note that if you a married or divorced couple is on the phone consult or at the appointment to meet AHEAD OF TIME to prepare and AGREE to an agenda. It is important both parents remain as team mates for the treatment process and their child.
g) READ about treatments, lab tests, and information you wish to discuss prior your doctors 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 of a treatment concept.
Once you have prepared and have that upcoming appointment, the question that usually follows “why are they so expensive” is “How can I pay for all of this and get the medical treatment my child needs??”
If you cannot afford a DAN doctor / autism medical specialist due to co-pays or “no-pays” due to health insurance coverages there are some suggested ways to paying for these important services and treatments. There are several ways folks are getting funding for these services.
Here is my list:
1) Foundations: Some foundations have grants just for funding medical care. These are not easily tracked and change as the foundation funding changes or applications received. In addition, this process requires a lot of research and paperwork to receive the yes or no answer. Please note TACA does not have a listing of these grants as the process is too complex and unique to each family to collect.
You have to do the research on your own. Type in FOUNDATIONS at Yahoo.com or Google.com. It is some work to find them, but several families in TACA have done this successfully.
2) Loan: Get a loan from your bank. Some banks offer low interest loans for medical care. This varies by bank and requires some research on your behalf. Read Who Pays for What?
3) Pro-bono work: MANY special doctors offer pro-bono services or have labs or suppliers they collaborate with in helping families in need - meaning free services and product 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 IS 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. You can find a list of doctors in our Resources section.
4) Payment terms: Many doctors will allow you to pay monthly a set fee that meets every budget. Organize this arrangement PRIOR to services commencement and in writing with their office.
5) Family: It is time to ask family for help. Instead of birthday and holiday gifts, the best gift is cash to help you with your child's needs. Better yet, ask for a loan for medical care fees.
These are some suggestions in helping you understand why the fees are so high and some suggestions on getting the help your child needs. This is not medical advice.
Important notes from the editor:
- Autism is biomedical in nature and each child deserves proper medical care to their address their unique needs. This entire situation of health insurance coverages and medical costs is very frustrating process but well worth the effort. In addition, that is why it is I recommended you read and support the Autism Treatment Network – another not for profit organization trying to help this process.
They are doing some important work that could change the future for this important problem affecting many families. You can read more about this at www.autismtreatmentnetwork.org or hear a radio show I did back in January 2005 on this topic on Autism One Radio. It is free – here is the link Autism Treatment Network ( from a 01/28/2005 radio presentation) www.autismone.org/radio/default.cfm?archive=26
- There are no guarantees on health insurance reimbursement but if you get educated on the process of reimbursements, proper insurance billing coding, good documentation, and frequent calls to your provider you will be more successful in the process.
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