Ethel Faust and Danielle Sharpe have been fighting for months to get Wellmark to cover their sons' autism treatments. "I found it very frustrating," says Faust, "Both as a parent and as a professional."
Both women have medical degrees and say the system is shortchanging children who deserve services like speech therapy. Faust and Sharpe appealed Wellmark's denials. Faust's was overturned, while Sharpe's was upheld.
Danielle filed for external review and discovered a Wellmark employee was sending out incorrect medical information about her son. ""My kid has enough issues, I'm not going to leave wrong diagnoses in his file and ten years later have them say something is a preexisting condition! I'm not OK with that," she says. Sharpe hired an attorney and Wellmark admitted the mistake and called it "human error." The insurance company also agreed to cover Spencer Sharpe's speech therapy, and reimburse the family for services it had paid for out of pocket.
As for Ethel Faust, she paid for a genetics test for her son Devon out of pocket. Wellmark's medical director reviewed the case and determined the test should be covered. The company was supposed to reimburse Ethel, but instead paid the lab. Ethel is still out more than one thousand dollars and the lab has now been paid twice.
Wellmark responded to our request for an interview with "no comment" but did send a letter to the Iowa Insurance Commissioner stating that changes are being made in the way it handles claims related to autism and speech therapy.
Both women have medical degrees and say the system is shortchanging children who deserve services like speech therapy. Faust and Sharpe appealed Wellmark's denials. Faust's was overturned, while Sharpe's was upheld.
Danielle filed for external review and discovered a Wellmark employee was sending out incorrect medical information about her son. ""My kid has enough issues, I'm not going to leave wrong diagnoses in his file and ten years later have them say something is a preexisting condition! I'm not OK with that," she says. Sharpe hired an attorney and Wellmark admitted the mistake and called it "human error." The insurance company also agreed to cover Spencer Sharpe's speech therapy, and reimburse the family for services it had paid for out of pocket.
As for Ethel Faust, she paid for a genetics test for her son Devon out of pocket. Wellmark's medical director reviewed the case and determined the test should be covered. The company was supposed to reimburse Ethel, but instead paid the lab. Ethel is still out more than one thousand dollars and the lab has now been paid twice.
Wellmark responded to our request for an interview with "no comment" but did send a letter to the Iowa Insurance Commissioner stating that changes are being made in the way it handles claims related to autism and speech therapy.
