Billing

Something about this doesn't sit right with me.

Earlier this year I found an in-network provider of ABA hours through my health insurance. The BCBA running the program used to work in my son's first school so she knew him. We met and discussed her program. She said she like to get the kids out of the house doing community experiences, social skills classes, swimming, etc. I stopped her right there and said I was not in position to shell out for a bunch of classes if that was going to be necessary. She told me that the classes were covered because they were part of the therapy. We got started and it seemed to be going well. Then. a few weeks into the program, I got an email telling me that she wanted to bill me extra to cover "expenses" not covered by insurance like the swimming and incidental expenses when they go out in the community. She wanted to double my co-pays (an extra 120 a month). I told her that I already provided a few dollars for each community outing and that I could not budget to double my co-pays. I pointed out that I had specifically asked about the cost of the class before we started. SHe dropped the issue.

A few months later I got a bill for double my co-pay amount. I emailed and asked what was going on. SHe replied "We talked about this - it is for extra expenses". I reminded her that we DID talk about it and that I had said that was not ok. As an in-network provider it is illegal for her to bill me beyond the co-pay. Since then she has started dropping all his acitivties. SHe only wants to send a therapist to work alone with him in his room. She doesn't even want him going otu for community experience. SHe has told me that she either wants me to pay out for swimming or to get disabilty to pay for it. Here is the kicker - she wants me to cover the cost of swimming so she can have her therapist dribve him there and she can bill the time as ABA. Does that sound like fraud to you? My husband took Sam to the swimming class once because the therapist was sick. There was nothing for him to do but sit and watch and then get Sam changed after. If there therapist were in the water with him I could understand calling it ABA but if there therapist just takes him there and I am paying for the class, how is that ABA? If she has to cut the class because she can't run her business that way then that is fine but she shouldn't ask me to pay for something that she then wants to bill as one of her services.

I understand she has to run her business and be able to make a living but it feels likes dropping everything that involves taking him out of the house is just mean spirited. Sam loves to go out and they know that. Sam already get "at the table" ABA all day at school and we have a home program from the school. The whole point of signing up with this provider was to add something different to his schedule. It was also to get a little respite for the rest of the family members. I used his Wednesday outing to take a shower - it was the only time possible. I used his other outing to take Maya out. If they are in his room every time then that is all out the window. Going on a community outing doesn't cost her any extra. I send a rather critical email to the group last night so now I am waiting to get kicked out of the program.