Duty to Care

Behavior is anything a person does. Can a dead man do it? If the answer is yes, then it is not behavior and should not be tested

Tom Blessing achieved Indiana victory with autism expanding Applied Behavioral Analysis (ABA) services for beneficiaries older than 21.

Insurance companies have a duty to care, to accept treatments consistent with generally accepted standards of care and cannot impose stricter restrictions based on financial self-interest. Effective treatment should both treat current and underlying conditions. Comorbid disorders can interact in a “reciprocal way” and should require a comprehensive, coordinated approach. Placement in the least restrictive environment is only appropriate if it is safe and has equal and effective benefits as treatment in a more restrictive setting. Before discontinuation of services, insurance must account for the motivation and willingness of the patient to participate. Requiring improvement within a ‘reasonable time’ can be unreasonable and abusive (Wit vs. United Health Care, 2019).

Independent external review agencies can be held accountable for the decisions they make. External review agencies must be appropriately credentialed, privileged and qualified to render recommendations and all medical documents specifying medical need must be reviewed (Marjorie K. & Preston K. v. Anthem Blue Cross and Maximus, and Joseph K vs Blue Shield of CA and Maximus, the DL Law Group, 2019).

The vision and intent of IDEA is for children with disabilities to make meaningful progress in our education system and achieve ‘appropriately ambitious’ objectives. The Individualized Education Program (IEP) must give kids more than just minimal, educational benefit (Endrew F.V. Vs. Douglas County School District, 2017).