Why Advocating for Your Child with Autism Matters in Medical Billing
Tymber, Office Manager/Biller
Raising a child with autism comes with unique joys and challenges—one of the most underestimated of which is navigating the complex world of medical billing. Between therapies, specialist appointments, diagnostic assessments, and insurance claims, the financial aspects of autism care can quickly become overwhelming. That’s why one of the most critical roles you can take on as a parent is that of an advocate—not just for your child's medical care, but for the billing and insurance process that follows.
Being proactive in understanding and challenging medical bills can ensure your child receives the care they deserve without incurring unnecessary financial strain. Here’s why your advocacy matters:
1. Insurance Often Doesn’t Get It Right the First Time
Errors in coding, misapplication of coverage rules, or denials for services that are actually covered under your plan are all common. If you don't speak up, these mistakes could lead to hundreds—or even thousands—of dollars in unnecessary out-of-pocket costs.
2. Autism Services Can Be Complex and Multi-Faceted
From ABA therapy to occupational therapy, speech-language services, and developmental pediatrics, your child may require a wide range of care. Ensuring each service is billed correctly and covered appropriately means keeping a close eye on every Explanation of Benefits (EOB) and invoice.
3. Not All Providers Understand Your Rights or Coverage
Some clinics or providers may not be aware of state-mandated autism insurance laws or may not bill in a way that maximizes your coverage. Advocating for proper billing can make the difference between receiving full benefits and being undercharged or denied care.
4. Appeals Can Make a Difference—If You Know to File One
Many parents don't realize that an initial denial from insurance isn't the end of the road. By reviewing bills, documenting everything, and filing an appeal when needed, you often have a solid chance of overturning a denial and receiving proper reimbursement.
Tips to Strengthen Your Advocacy:
● Keep detailed records of all services, dates, providers, and communications related to billing.
● Know your insurance policy inside and out, especially sections related to autism spectrum disorder (ASD) coverage.
● Request itemized bills and cross-check them against your child’s care logs to catch discrepancies.
● Don’t be afraid to ask questions—call your insurance provider, speak to the medical billing office, and escalate when necessary.
Advocating for your child may not always be easy, especially when you're already balancing so many responsibilities. But when it comes to medical billing, your persistence can protect both your finances and your child's access to essential care.