Kevin R. Wexler/STAFF PHOTOGRAPHER
Al Schiavo and his girlfriend, Julie Skolnik, in the Hawthorne bedroom of Schiavos 10-year-old son, Spencer. The hole in the wall was made by Spencer, whose autism sometimes causes violent outbursts.
As most people were finishing last-minute holiday shopping, members of Spencer Schiavos family were frantically working to create what they have called a miracle.
Thats what it took, they said, to reverse a surprise insurance company decision that would have forced 10-year-old Spencer to leave an intensive treatment program for his severe autism by the weekend after Christmas.
Al Schiavo and his son Spencer at the boys treatment center in Baltimore.
Convincing the company, AmeriHealth, to reconsider took dozens of phone calls and letters from Spencers teachers and caregivers, many of whom his family had to track down after they had left their offices for the holidays. Spencer and his twin brother, Griffin, live with their father, Al Schiavo, and Als longtime girlfriend, Julie Skolnik, in Hawthorne. His mother, Hana Greene, lives nearby.
Their efforts paid off with a brief phone call on one of the last business days before Spencers time at the renowned Kennedy Krieger Institute in Baltimore was to run out. The message: Spencer could continue at the institute until at least February, by which time they hope treatment will be complete.
By many measures, it was a happy ending. Spencers advocates had persuaded an insurer with one of the largest networks in New Jersey to spend tens of thousands of dollars in an attempt to make him better. The four- to six-month program is meant to curb Spencers impulses to hurt himself, a tendency the family feared was about to force them to commit him to an institution.
The battle was one of dozens the family has waged to get Spencer access to often staggeringly expensive services for children with autism, and to navigate the complicated system of state and federal laws that are meant to help families access such care. It is one of countless such disputes between families of people with autism and their insurance companies every year.
In response to a growing body of research showing the efficacy of early treatment, state and federal authorities have required insurance companies to increase their coverage for the condition and provide appeals processes for families who believe their claims were wrongly denied. New Jersey passed such a statute in 2004.
Originally posted here:
Bergen County parents persuade insurer to treat autistic son after coverage is denied