Sunday, April 29, 2012

AMC Sensory Friendly Movie Pirates! Band of Misfits!

Sensory Friendly Version Coming to AMC Coral Ridge 10!

AMC Entertainment® and the Autism Society of America have teamed up to bring families affected by autism a special opportunity to enjoy their favorite films in a safe and accepting environment on a monthly basis.
With Sensory Friendly Films, the movie auditoriums will have their lights brought up, the sound turned down and no previews.  For those families who don’t get to go to the movies because it’s too difficult, this is the movie for you!!! It’s an event that the entire family will enjoy!!!!

Here's the "When and Where" for this event...

Saturday, May 5, 2012
10:00am until 12:00pm
AMC Coral Ridge 10
3401 NE 26th Ave
Fort Lauderdale, Fl 33306
(Just east of Federal Highway, north of Oakland Park Blvd – Behind Target)
            954-566-9677    

For tickets to this unique experience, please visit the theatre’s box office the day of the event. Tickets are $5

Upcoming Shows
June 16 - Madagascar 3: Europe's Most Wanted

*Please note all dates and films are subject to change
Never miss a movie!
Sign up for the Autism Society's free e-newsletter for updates on upcoming Sensory Friendly Films, as well as the latest info on autism news, advocacy, research, education, conferences and resources!

Insync with Autism

Jonathan is absolutely going to LOVE this...
Update...
We're here and Jonathan is REALLY into the music!


insync with autism 


A Harmonious Experience For Individuals With Autism

 
TO RSVP CLICK HERE
Please include name, phone, and # of seats in email.
Help us support future concerts by purchasing gift items!
INSYNC With Autism is pleased to announce their sixth event to be held at the New Horizon United Methodist Church on Sunday, October 31st, 2010.
We are excited to present "The Florida Youth Orchestra" for this event. 
***Please come in costume for Halloween!
***Pre-Concert Trick-or-Treating and Art Activities start at 2:30PM, concert from 3-4:15PM
The hands-on musical program, INSYNC With Autism – A Harmonious Experience for Individuals with Autism, will feature an interactive musical performance that can be enjoyed by the entire family. This musical performance will be presented free of charge to individuals affected by autism and their families through funding by The Rotary Club Of Weston in partnership with UM NSU Center For Autism and Related Disabilities.
INSYNC With Autism aspires to improve the quality of life for families affected by autism by providing them with a safe, fun community experience.
The concert series is specifically tailored to be “autism friendly” and will enrich the lives of those with autism through the power of music. INSYNC With Autism provides a unique opportunity for individuals affected by autism, their families, and friends from the community to experience the concert in a relaxed environment. The theatre provides an open space for individuals to dance, jump, or relax to the music without the difficulties that a larger venue might bring. Audience members will be given the opportunity to learn how music can enrich the lives of individuals with autism by actively participating with different percussion instruments.
TO RSVP CLICK HERE
Please include name, phone, and # of seats in email.

Thursday, April 26, 2012

Epsom Salt for Autism?

We're always looking for light reading between tasks on what we can do for our son to overcome the negative effects of Autism, and so I was intrigued when I found an article on Epsom Salt.  I guess what kind of stuck out in my mind was the fact that lately, we've had to give him Miralax for constipation and I know that the active ingredient in Miralax is actually Magnesium.  Well, Epsom Salt is not really salt, it's really just Magnesium Sulfate.  Not to go too much into another subject, but another article we wrote here, about a Tylenol and Allergy Link, it turns out that the Sulfates in Epsom Salts, can replenish the Sulfates used up in the Liver, due to taking Tylenol.  It should be noted however, that some studies make it unclear if both should be taken at the same time, so talk to your doctor.
To make a long story short, I've been putting a cup in Jonathan's bath every other day and I've found that he sleeps better, has less allergic outbreaks and seems to be able to concentrate on tasks we give him a bit longer than before.  The only thing I would like to say though, before continuing on to read the article, is to double check with your doctor, since the Magnesium or the Sulfate might interact negatively with Medication your child might be on.
Here's the Article, and you decide.


My mother taught me about Epsom salts for aches and pains. She would swear by it and I would ignore it; chalking it up to another old wives tale she told me. But then autism entered our lives and suddenly I was reading about the magic of Epsom salt baths. Could my mom actually have been right about this? Well, yes.
The reason I learned about Epsom salt baths for my son with autism was due to the research I was conducting on some of his physical and behavioral symptoms he displayed. It turned out that he has trouble with his PST (phenol-sulfotransferase) system and the processing of phenols and salicylates.
Symptoms of PST/sulfate deficiency (problems with phenols/salicylates) are reddened ears, hyperactivity, inappropriate laughter, night sweats, black under eyes, excessive thirst, eczema, facial flushing, trouble falling to sleep, disturbed sleep and odorous bed-clothes.  Your child doesn’t have to exhibit all of these symptoms in order to have trouble with phenols.  My son gets most of these symptoms and he not only becomes very hyper, but he starts to stim and he has trouble with emotion regulation.
Ready for the medical science behind this? One very important sulfotransferase enzyme is the one that attaches sulfate to phenol compounds, called phenol-sulfotransferase (PST). The PST is under active in the majority of autistic children. Without the PST enzyme working properly, the liver will have trouble eliminating the phenols in food.  PST is a Phase 2 liver enzyme that detoxifies leftover hormones and a wide variety of toxic molecules, such as phenols and amines that are produced in the body (and even in the gut by bacteria, yeast, and other fungi) as well as food dyes and chemicals.
OK, so what are phenols?  Phenols are present in food dyes, artificial flavors, preservatives and in highly colored fruits and vegetables, in bioflavonoids, and in carotenoids (carotene, lutein, lycopene, xanthophylls, and zeaxanthin).  Almost all foods have phenols, but in varying amounts. Salicylates are a subgroup of phenols.Salicylate is a group of chemicals related to aspirin. There are several kinds of salicylate, which plants make as a natural pesticide to protect themselves.  Foods high in natural salicylates are tomatoes, apples, peanuts, bananas, oranges, cocoa (chocolate), red grapes, coffee, all berries, peppers (bell & chili) to name a few.  My son can’t tolerate too many phenols/salicylates. He reacts to tomatoes (yes, ketchup and pasta sauce!), chocolate, red grapes, and artificial colors/flavors.
Most children on the autism spectrum are very low in sulfate due to a deficiency in this PST pathway.  Since sulfur intake is low, and its oxidation is slow in many autistic children, phenols and salicylates that requires or uses up sulfate ions during its metabolism, will make the situation worse.  Tylenol is phenolic and one or two minutes after a dose of  Tylenol, the entire supply of sulfate in the liver is gone!
So, what’s a mother to do? Well, listen to their mother. Epsom salt baths. One way to enhance detoxification is to supply more sulfate.  This increases the amount of toxins processed out. Sulfate ions may not be absorbed well from the gut, so simply giving more sulfur directly by swallowing supplements may not produce satisfactory results.  This may be because their body is unable to convert the sulfur to the needed sulfate form. Epsom salts are magnesium sulfate which is readily available to support the PST pathway. You can purchase Epsom salts at Costco, Wal-Mart or your local grocery and health food stores. Be sure to purchase U.S.P. (United States pharmaceutical grade).
When given an Epsom salt bath, the magnesium and sulfate in the salts are absorbed into the body through the skin. Because the sulfur is already in the sulfate form, it does not need to be converted like other forms of sulfur do. Sulfate is thought to circulate in the body up to about nine hours. Any Epsom salts left on the skin may continue to be absorbed as long as it is still on the skin, offering continuous ‘timed-released’ input into the bloodstream.
I put 1.5 to 2 cups of Epsom salts in hot bath water to dissolve and then add the cold water to balance the temperature. My son will soak for about 15 minutes before I use natural soaps or shampoos. Others add baking soda and lavender oil to enhance the relaxation effects.  I give my son an Epsom salt bath at least 5 nights a week, others do less.  It really soothes and calms him for bedtime.
I’ve finally decided to take heed to my mother’s old wives tales she’s been sharing with me for the past 40 years. There is something to be said about listening to your mother.  But perhaps we should refer to them as “old wise tales” from now on.

Friday, April 13, 2012

Milk Egg and Soy Free Cake

I found this FANTASTIC Recipe at Milk Allergy Mom

Milk and Egg Free Cake



This is our go-to cake recipe every time! It's yummy, moist cake that nobody will know is dairy/egg free.

Known as 4-H cake/depression cake/crazy cake/wacky cake.

This recipe is for 12 cupcakes, a 9x9 cake, and an 8x8 cake.

Double ingredients for 24 cupcakes, double layer round cake, or 9x13" cake.

Heat oven to 350.

Grease pan(s) with an allergy safe food if you are making this for someone with food allergies. We have luck with most Pam sprays and Fleischmann's Unsalted Margarine Sticks.

1.5 c flour
1 c sugar
1/4 cup cocoa powder
1 tsp baking soda
1/2 tsp salt
1 tsp vinegar
1 tsp vanilla
1/3 cup oil
1 c cold water

Combine ingredients and pour into greased pan or muffin tin. Bake in oven until done, when cake springs back to the touch or a toothpick comes out clean. Time varies on the pan you use, 15 to 30 minutes possibly.

Our favorite icing for this cake is Pillsbury Creamy Supreme from a tub. It comes in flavors of Chocolate Fudge, Classic White, and Cream Cheese, and for now they are all dairy free. They all contain soy. Check labels because Pillsbury WHIPPED icings DO contain milk.

Substitutions:

Vanilla CakeOmit cocoa. Double the vanilla. Add 1/4 more cup flour. 

Spice Cake: Omit cocoa. Add 1 Tb pumpkin spice. Add 1/4 more cup flour. 

Orange Cake. Omit cocoa & vinegar. Use orange juice for the water. Add 1/4 more cup flour. 

Lemon Cake: Omit cocoa. Use lemon juice for vinegar. Can add some lemon extract. Add 1/4 more cup flour.

Monday, January 31, 2011

Tylenol May Not Be Safe For Our Kids


We need to use our brains with this research, obviously if your kid has a high fever, you don't want to risk brain damage, but at the same time for a little boo-boo, try to avoid the Tylenol.

Acetaminophen May Cause Asthma in Children

The huge rise in Asthma among kids may be caused by
excessive acetaminophen usage.
Summary
comparative study involving children from many countries across the world was conducted to investigate the increased risk of asthma and other allergic disorders like rhinoconjunctivitis (characterized by itchy watery eyes and a runny nose) and eczema (skin rashes) upon intake of acetaminophen. The results suggested a dose-dependent increase in the symptoms of asthma when acetaminophen had been used in the past 12 months.

Introduction

The use of acetaminophen to treat fever is very common and has been practiced for more than 30 years. Although acetaminophen is easily available and commonly used, it has been previously reported that its frequent use could increase the risk and severity of asthma in young children. Hence, a study was done on adolescent children aged 13 to 14 years, to assess the impact of acetaminophen use on asthma and related symptoms. According to the findings, “acetaminophen use may represent an important risk factor for the development and/or maintenance of asthma, rhinoconjunctivitis and eczema in adolescents.”

Methodology

•    This study was conducted as a part of the International Study of Asthma and Allergies in Childhood (ISAAC).
•    More than 300,000 children aged between 13 and 14 years from 50 countries were asked to complete three questionnaires: one video and two written questionnaires.
•    The first written questionnaire was designed to obtain data on the symptoms of asthma and the general prevalence of asthma in that particular region. The second questionnaire gathered information about the risk factors as well as protective factors for asthma. The questions were simple and were either “yes/no” type or a “multiple-choice” type. The video questionnaire had a video presentation of asthma and its symptoms.
•    The answers from each questionnaire were sorted and interpreted with respect to certain statistical methods.

Key Findings

•    There was a significant increase–almost two-and-a-half times–in asthma (specifically, wheezing) on exposure to acetaminophen at least once a month.
•    A dose-dependent correlation was also seen between the use of acetaminophen and symptoms of rhinoconjunctivitis in some children.
•    A few children had eczema–skin rashes and itching, which again were related to the acetaminophen medication.

Next Steps

This study theorizes on the association between acetaminophen use and asthma-based responses of adolescent children. Although there are some ideas on scientific explanations for this association, they have yet to be confirmed. Randomized controlled trials are needed to further investigate this connection. Additional research in this area can be helpful in advising consumers on use of acetaminophen and other fever-reducing drugs.

Conclusion

This study significantly linked the worsening of asthma symptoms with acetaminophen use. Acetaminophen was also shown to increase symptoms of rhinoconjunctivitis and eczema. This information was already available for younger children aged 6 to 7 years. This report extended the findings to adolescent children. Thus, use of acetaminophen may not be safe in all patients and it should be taken with caution and under medical supervision.
Read the entire report

Read more at FYI Living: http://www.fyiliving.com/health/allergy-asthma/is-tylenol-safe-for-kids/#ixzz1szuib4HM

Saturday, January 15, 2011

Boca's TOPSoccer Program Could Become a National Model

Boca's TOPSoccer Program Could Become a National Model

Thursday, July 08, 2010

Hang On to Your Treat Receipt | Starbucks Coffee Company

You guys know me, I'm always looking for the "Deals" ... LOL!!!
Hang On to Your Treat Receipt | Starbucks Coffee Company
Hang On to Your Treat Receipt
Hang On to Your Treat Receipt


From June 29 to October 4, make any purchase before 2pm and enjoy any Grande cold beverage for just $2 (plus tax) after 2pm the same day at participating U.S. stores. Just remember to show us your receipt when you return and have a cold one on us!

Saturday, June 06, 2009

Jonathan Riding His Bike




After SIX MONTHS of back breaking work, (basically manually keeping my hands on his feet so they stayed on the pedals, while hunched over!) Jonathan is finally riding on his own!

 WOOHOO!!!

After reading research showing that Cycling reduced tremors in Parkinson patients and increased motor function, I felt that it was imperative that Jonathan learn how to ride a bike.  While Autism isn't Parkinson's disease, they have a lot of similarities, and I felt either way it couldn't possibly hurt.

Thursday, March 12, 2009

Cleaning Products Exposed!

With everything that we're trying to do to help our kids, one of the things many of us have overlooked is the effect of the Environment on our kids.  Expecially our home environment.  There are studies that show that women who work from home have a much higher risk of cancer, than those who work out of the home.  The EPA says this is a direct link to the chemicals we use in our homes.  The biggest obstacle we face though, is what exactly to use to replace our chemical laden cleaners.  Here's a great guide that I found, (that I also poosted on one of my other sites), to help you get started.

Posted on July 8th, 2008 by ddowns
Deciphering Labels and Going Green to Protect Your Health and Environment

When you clean your oven, toilet, bath tile, kitchen floor, or windows, you can smell the toxins. The label even warns you to wear gloves, avoid contact with skin and eyes, and please do not breath the fumes. If it’s too dangerous to touch it can’t be clean. What kind of residues are left in your oven, where you prepare food for you family? What about that kitchen floor your children are crawling on or the bathtub they are sitting in?

These everyday products diminish indoor air quality by introducing a plethora of harmful chemicals. Is it possible that the air inside your home is 5 to 100 times more toxic than the air in Los Angeles, Atlanta, or Chicago? If you use bleach, traditional cleaning products, air fresheners, dry cleaning services, or other common household chemicals, it probably is.

The EPA reports poisonings as the #1 cause of hospital visits by children. Some hospitals report 79% of all poison control center cases involve children, 64% occur in children under age 5. The toxins commonly found under a kitchen sink are often the culprit. We welcome toxic chemicals into our homes in the name of cleanliness, but how clean is a home full of carcinogenic residues?
Green alternatives are the only alternative. As the truth about the chemical and petroleum industries leaks, consumers are faced with harsh realities. People want to protect their families, but it is hard to read between the advertising lines. Marketing gurus put flowers on bottles of poison, use the word ‘green’ to distract from a petrochemical additive, and leave out ingredient listings all together. The fact is chemical companies don’t have to list the ingredients on household cleaning products.

Here’s the research. This is not a complete or exhaustive list of all the possible ingredients in that spray that claims to be safe around food. The only way to truly get all the information is to check out the Material Safety Data Sheet or Mass Spectrometry results posted on the manufacturer’s website. I’ve divided ingredients into three categories based on safety first.

The Dark Side: Chemicals that Harm

Petrochemicals: These are petroleum based products that leave dangerous residues. These products may be derived from oil, coal, or natural gas and used to make plastics, pesticides, health care products, and cleaners. These chemicals have been linked to cancers, neurological illnesses, and environmental devastation. Dry cleaning chemicals, such as perchloroethylene, are part of this group. These chemicals are commonly listed as ethylene, propylene, benzene, benzol, annulene, phenyl hydride, diethanolamine, triethanolamine, monoethanolamine, and xylene.

Tetrachloroethylene: also called perchloroethylene, used as a dry cleaning solvent and degreaser, cause skin rashes, headaches, and dizziness Amyl acetate: a synthetic grease cutter, is a neurotoxin implicated in central nervous system depression, found in conventional furniture polishes.

Naphthalene: a member of the carcinogenic benzene family derived from coal tar or made synthetically, known to bio-accumulate in marine organisms, causes allergic skin reactions and cataracts, alters kidney function=2 0and is extremely toxic to children, found in conventional deodorizers, carpet cleaners, toilet deodorizers.

Methylene chloride: also called dichloromethane, is a volatile, colorless liquid with a chloroform-like odor, used in various industrial processes including paint stripping, pharmaceutical manufacturing, paint remover manufacturing, and metal cleaning and degreasing, beware of inhalation and skin exposure. OSHA considers methylene chloride to be a potential occupational carcinogen.

Ammonia: The scent alone will tell you to stay away. This chemical can irritate the lungs, eyes, and mucus membranes. It is extremely dangerous when mixed with other chemicals such as bleach. Ammonia adds nitrogen to the environment often resulting in disruptions to the ecosystem including toxic effects to plants, fish and animals. Ammonia is included as a toxic chemical on the EPA’s Community Right-to-Know list.The FDA also regulates the amount of ammonium compounds in food. Ammonia is found in conventional window cleaners.

Chlorine: The bleaching agent in household bleach such as Clorox. Though it will get whites whiter, this chemical is extremely irritating to the lungs, skin, and mucus membranes. It was used as a powerful poison in World War I. Chlorine is the household chemical most frequently involved in household poisonings. Chlorine also ranks first=2 0in causing industrial injuries and deaths resulting from large industrial accidents. The residues left behind, known as organochlorides, have been linked to many cancers including breast cancer. Studies have also shown a link between chlorine exposure from pools and the development of asthma in young children.

Aerosol Sprays: Once contained chlorofluorocarbons (CFCs) until prohibited because of effects on the ozone layer. The most common replacements are mixtures of volatile hydrocarbons, typically propane, n-butane and isobutane, all flammable petrochemicals.

The Green Side: Safe for You, Green for the Planet

Hydrogen Peroxide: This common first aid kit essential can act as a bleaching agent and disinfect surfaces. It is not recommended on colored fabrics. It works, but if it is the primary ingredient in your cleaning product, better to buy the 89 cent version at the drugstore.

Enzyme: It’s a protein. Enzymes occur naturally in our foods, our bodies, and our environment. The enzymes in cleaning products are designed to munch apart the grime. Most enzymes are safe on a variety of surfaces and even fabrics. They do not bleach or stain or have fragrance. Enzymes are a truly natural means to clean.

Mineral Salts: From table salt to your granite countertop, there are plenty of mineral compounds in your home. You may have used common table salt and ice to scour a scaly coffee pot. Baking soda is common in detergents and even toothpaste. Some salts have been found especially effective on soap scum.

Lemon juice: This fruit juice is acidic and can bleach some stains. It can leave behind sugars, so be sure to rinse surface with plenty of water. Makes a great alternative to beauty creams or acne medication as it dries up oils and brightens skin.

Baking soda: This common baking ingredient is a basic salty scrub. It can help remove mineral deposits (with a lot of elbow grease) and works great to freshen carpet or laundry. Sprinkle on and vacuum up. It can remove tarnish and was even used to clean the Statue of Liberty.
The Fence Sitters: Interesting Origins, Inconsistent Results.

Boric acid: Although generally not considered to be much more toxic than table salt, it is poisonous if taken internally or inhaled (can damage liver, kidneys, mucous membranes, and nervous system). This chemical has been considered green because it naturally occurs. The common insect deterrent may be toxic to aquatic life.

Vinegar: Common pantry item is an acidic solution that can be used on glass. It will remove fingerprints but leaves a sour smell.

Surfactant: Comes from ‘surface acting agent’ and literally means an agent that acts on surface tension. For cleaning purposes, it breaks up soil, dirt, and grime. Avoid chemical surfactants. Plant-based surfactants are safe and can be very effective.

Going Green
The green cleaning product revolution is evolving. Now there are numerous products on the market that aim to protect you, your family, and the environment. But no two eco-friendly products are alike. This guide to ingredients should help you dissect the labeling. Look for cleaners that are enzyme based, plant-based, and fragrance-free. Perfumes and dyes contribute to respiratory problems and multiple chemical sensitivity disorders.

The first step to protecting yourself and your family from common household toxins is information. Then, once you’ve gotten rid of the junk under your sink, check out great plant-based alternatives for your entire home. Ingredients are everything, so search websites and natural stores. When it comes to protecting your health and the environment, it’s best to be choosy.

Monday, February 02, 2009

Help with Petition for Appeal

I'm trying to get my insurer to cover ABA Therapy for my son, and I found this fantastic sample letter, that would be perfect. If I lived in California. Unfortunately, I live in Florida. Is there anyone out there that might be able to help me convert this letter to Florida-ese case law?

Sample Insurance Letter

VIA CERTIFIED MAIL

INSERT CLAIM HANDLER’S NAME
CLAIM HANDLER’S TITLE
CLAIM HANDLER’S CITY STATE ZIP

RE: ENROLLEE’S NAME
ENROLLEE’S DATE OF BIRTH
ENROLLEE’S SOCIAL SECURITY NUMBER
HEALTH PLAN PURCHASER’S NAME
HEALTH PLAN IDENTIFICATION NUMBER
CLAIM NUMBER
SUBJECT: Payment Authorization for Enrollee’s autism

Dear:

Please deem this letter to be a formal, urgent and continuing request for you to promptly authorize payment of multi-disciplinary therapeutic interventions recommended by the Enrollee’s treating healthcare provider(s) in the enclosed report(s) as being medically necessary, now and over a period of time.

As you can see from the enclosed report(s), the following is recommended:

  • A number of speech therapy sessions spread out over a consistent period of time;
  • A number of occupational therapy sessions spread out over a consistent period of time;
  • A number of physical therapy sessions spread out over a consistent period of time;
  • A number of recreational therapy sessions spread out over a consistent period of time;
  • A number of behavior modification therapeutic sessions spread out over a consistent period of time;
  • A number of discreet trial training therapeutic sessions spread out over a consistent period of time;
  • A number of professional progress and assessment evaluations spread out over a consistent period of time;
  • Medication treatments as needed;
  • Parent training sessions as needed;
  • Brain imaging and other diagnostic laboratory testing as needed to assist in the direction of future treatment; and
  • Other types of non-experimental and non-investigational interventions that are known in their respective disciplines to be reliable in treating and reducing the more severe aspects of autism.

CALIFORNIA STATE MANDATE LAWS

While you may be trained in the meaning of different terms in your company’s health care plan, please remember that any contractual terms in your plan that attempt to limit coverage for autism are unenforceable in California if they violate California’s state mandates on minimal levels of autism care. Samson v. Transamerica (1981) 30 Cal. 3d 220, 231.178. Cal. Rptr. 323, 350.

Your company had to agree to these state mandates as a condition of doing business in California.

These state mandates are in two forms: firstly, general state mandates that apply to all medical conditions; secondly, state mandates that specifically require that all medically necessary care for autism be covered. These state mandates are not preempted or overruled by contrary federal ERISA law. Metropolitan Life v. Massachusetts (1985) 471 U.S. 724.

For instance, your company had to agree to offer in California general or “basic health care services” to all medical conditions, including “physician referrals, hospital inpatient serves, home health services, preventive and emergency healthcare services.” Health and Safety Code 1345(b) (1)-(6); 1367(i).

Your company had to also agree to provide specific treatments for autism that are “medically necessary,” that do not discriminate based on age, and that cover an amount equal to those benefits offered “to other medical conditions.” Health and Safety Code 1374.72(a) and (d)(7); Insurance Code 10144.5(a) and (d)(7) [known as AB 88]

In relation to treating autism specifically, your company had to also agree to cover “out patient services, inpatient hospital serves, partial hospitalization services, and prescription drugs if the [plan’s] contract includes coverage [already] for prescription drugs.” Health and Safety Code 1374.72(b)(1)-(4); Insurance Code 10144.5(b)(1)-(4) [part of AB 88]

URGENCY AND MEDICAL NECESSITY DEFINED

This letter just cited to you California state mandate law, general as well as specific to autism that nullifies any contrary coverage limitations that may otherwise be available to you in your contract terminology.

Consequently, I will now address California’s definition of “medical necessity” and the relevant medical literature which concludes that multi-disciplinary autism intervention works; in other words, such intervention is not experimental, speculative, or investigational.

The California Legislature has defined “medically necessary” as all care which is “reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.” Welfare & Institutions Code 14059.5

In the “historical and statutory notes” preamble to AB 88, the California autism state mandate, the California Legislature “declares and finds” conclusively that autism is “treatable” and that inadequate treatment “causes relapse and untold suffering” as well as “homelessness…and other significant social problems.”

In other words, the California Legislature has conclusively determined that autism intervention does indeed work – hence, it is not experimental and is indeed medically necessary.

The medical literature also proves the fundamental maxim that the earlier the autism intervention, the better the expected medical result:

“[A]t least six comprehensive [autism intervention] treatment programs designed to stimulate widespread changes in young children with autism have published positive outcome data in peer-reviewed journals… [paragraph]. All the studies reported (a) significant acceleration of developmental rates, resulting in significant I.Q. gains; (b) significant language gains in the treated children; (c) improved social behavior and decreased symptoms of autism…[paragraph]. Children with autism appear most able to benefit when intervention is begun very early, between ages two and four, making far more progress than do older children receiving the same interventions…, and when intervention is intensive, including 15 or more hours per week of focused treatment with very low child-to-adult ratios over one to two years or more.” Rogers, “Early Intervention in Autism” Journal of Autism and Developmental Disorders (April 1996), Vol. 26, No. 2, Plenum Press, New York and London, pp. 243-245 (citations omitted).

Clearly, when a healthcare plan refuses to authorize autism treatment at the earliest possible moment, it fails “ to prevent…significant [future] disability” and it fails “to alleviate severe pain” by preventing one from learning how to communicate and become productive and independent, in violation of what California mandates as “medically necessary” care under Welfare & Institutional Code 14059.5. Repeated violations of state mandates can cause your company to lose its license to do business in California.

Moreover, financial inducements to limit medically necessary care are illegal in California. Health & Safety Code 1348.6(a).

CONCLUSION

Because time is of the essence, I am requesting that you immediately authorize payment for all the interventions recommended in the enclosed report(s).

If there are any interventions for which you refuse to pay, please immediately identify those interventions and give the reasons which support your denial. Denials of coverage cannot be arbitrary or capricious. Insurance Code 790.03(h) (13) sates that it is an unfair claims settlement practice when:

“Failing to provide promptly a reasonable explanation of the basis relied on in the insurance policy, in relation to the facts or applicable law, for the denial of a claim or for the offer of a compromise settlement.”

Courts have applied Insurance Code 790.03, quoted immediately above, to self-insured corporations. Nathanson v. Hertz Corporation (1986) 183 Cal.App.3d 78,227 Cal.Rptr. 799, review denied.

SIMULTANEOUS PETITION FOR INTERNAL APPEAL

As to those claims which you intend to refuse to pay, if any, please deem this letter to also be a petition for appeal of said refusal within the appeal and grievance procedures set out in your plan. Pursuant to this appeal petition, I request that you immediately photocopy and distribute this instant letter and its enclosures to each and every member of each and every appeal and grievance panel procedurally recognized in your plan. This should guarantee that timely treatment remains a viable option. In other words, this should prevent your response from developing into an untimely treatment program that could forever injure the optional recoverability of your enrollee. Please carbon copy me on this distribution list and provide me with the dates and times in which I may appear before these panels to advocate my cause.

Please remember that under California law, managed care entities now have “a duty of ordinary care to arrange for…medically necessary healthcare service.” Civil Code 3428. Pursuant thereto, if the breach of this duty causes “substantial harm” through the unreasonable “denial, delay or modification” of services recommended for an enrollee, then the victim may sue. Injunctive relief to stop abusive managed care practices in court is no longer defeated by arbitration clauses. Broughton v. Cigna Healthplans (1999) 21 Cal.4 th 1066, 90 Cal.Rptr.2d 334.

REQUEST FOR ARBITRATION

As to those claims refused by you, which refusals your appeal panels intend to uphold, please then deem this letter to also be a request for arbitration of those refused claims. It is my desire to have an impartial arbitrator immediately hear my contention that the refused benefits are medically necessary, and hence must be provided. The above quoted general and autism state mandates, as well as the medical literature and the legislative preamble, clearly establish that the reliable autism interventions requested by me are medically necessary, and hence cannot be justifiably refused by you.

Courts have recognized that fair claims settlement practices described in insurance regulations:

“…establish the standard of conduct for insurers in California. Insurers who fought the regulations have no right to gain a competitive edge on insurers who scrupulously follow the regulations and faithfully discharge their obligations to their insureds. Insurers who follow the law should not be put at competitive disadvantage, particularly at the expense of insureds that may have valid claims.” Spray, Gould & Bowers v. Associated International Insurance Co. (1999) 71 Cal.App.4 th 1260, 1274, 84 Cal.Rptr.2d 552, 560-561.

As stated in Mariscal v. Old Republic Life Insurance Co. (1996) 42 Cal.App.4 th 1617, 1623, 50 Cal.Rptr.2d 224, 227:

“Insureds seek protection against calamity and purchase insurance to buy peace of mind and security. [citations omitted] The insurer has a duty to protect the insured’s interest as if it was its own, and it may not deny a claim without thoroughly investigating it. [citations omitted]

“A trier of fact may find that an insurer acted unreasonably if the insurer ignores evidence available to it which supports a claim. The insurer may not just focus on those facts which justify denial of the claim. If an insurer unreasonably refuses a claim, it is liable for breach of the covenant of good faith and fair dealing inherent in every insurance policy. [citations omitted]

“An insurer must liberally construe claims forms and the policy in favor of coverage; exclusions are strictly interpreted against the insurer.”

Failure of a managed care entity to timely provide arbitration pursuant to an enrollee’s request can free the enrollee to sue the managed care entity for coverage and personal injury damages in front of a jury. Engalla v. Permanente (1997) 15 Cal.4 th 951, 64 Cal.Rptr.2d 843.

Please immediately provide me with an arbitration date so my experts can appear to establish medical necessity. This arbitration will only be necessary if you continue to deny my appeal to you to reconsider my claim.

Very truly yours,

Sunday, August 24, 2008

Jonathan Goes Bowling!

The first time we took Jonathan Bowling, it was extremely difficult, he just wanted to run around and didn't want to participate. This time, we had 4 people playing, "Auntie" Denise, Jeanette, Juan and Jonathan. Not only was he very excited to play, but he patiently waited for his turn and cheered us on as WE played!

Navigating Autism: Jonathan's Journey to Better Sleep, Gut Health, and Well-being

  By Juan Fermin A s a parent, there's nothing more challenging than seeing your child struggle, especially when they can't articula...