[Your Name]
[Your Address]
[Your City, State, Zip Code]
[Your Phone Number]
[Your Email]
[Date]
Golden Rule Insurance Company
PO Box 31374
Salt Lake City, UT 84131-0374
Fax (801) 478-7581
To Whom It May Concern:
Re: APPEAL OF DENIAL OF INSURANCE CLAIM
I am writing to appeal the denial of my insurance claim for applied behavior analysis (ABA) therapy for my child, [child’s name]. [Child’s name] has been diagnosed with autism spectrum disorder (ASD), and ABA therapy is the most effective treatment for ASD. The insurance company has denied my claim, stating that ABA therapy is not medically necessary. However, the American Academy of Pediatrics (AAP) recommends ABA therapy as the first-line treatment for ASD. The AAP states that ABA therapy can help children with ASD learn new skills, improve their communication, and reduce challenging behaviors.
In addition, the Centers for Disease Control and Prevention (CDC) has stated that ABA therapy is an effective treatment for ASD. The CDC states that ABA therapy can help children with ASD improve their social skills, communication skills, and self-care skills. The insurance company has also stated that ABA therapy is a patient responsibility. However, the Affordable Care Act (ACA) requires insurance companies to cover ABA therapy for children with ASD. The ACA states that insurance companies must cover ABA therapy if it is medically necessary and if it is provided by a qualified provider.
I am requesting that you reconsider your decision and approve my claim for ABA therapy. I believe that ABA therapy is medically necessary for my child, and I believe that it is covered by my insurance plan.
I would also like to request that you expedite the review of my appeal. I am concerned about the delay in getting my child the treatment that he needs.
The Individuals with Disabilities Education Act (IDEA) requires public schools to provide ABA therapy to children with ASD if it is deemed necessary to help them achieve their educational goals. IDEA states that:
“The term ‘special education’ means specially designed instruction, at no cost to parents or guardians, to meet the unique needs of a child with a disability, including… applied behavior analysis.”
In addition, the Affordable Care Act (ACA) requires insurance companies to cover ABA therapy for children with ASD. The ACA states that:
“Insurance coverage shall include… applied behavior analysis and other habilitative services and devices… for children with autism spectrum disorder.”
The Arizona Revised Statutes (ARS) also require insurance companies to cover ABA therapy for children with ASD. ARS states that:
“A health benefit plan may not exclude coverage for applied behavior analysis services for the diagnosis, assessment, treatment, or management of autism spectrum disorder.”
I am requesting that you reconsider your decision and approve my claim for ABA therapy. I believe that ABA therapy is medically necessary for my child, and I believe that it is covered by my insurance plan.
Yours Sincerely,
[Parent’s Name]
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