Business Details
17 Years
experience
Mental Health & Autism Insurance Advocates
Founded in 2009, the Mental Health & Autism Insurance Project (MHAIP) was established by parents seeking better healthcare access for children with autism spectrum disorders. Our organization combines deep industry expertise with a mission-driven approach to help families, providers, and facilities secure medically necessary treatments through health insurance. With decades of collective experience in public health policy, education law, and patient advocacy, our team specializes in navigating complex insurance systems to ensure compliance with federal and state mental health parity laws.We provide direct services including pre-authorization support, claims processing, and appeals management while maintaining authoritative partnerships with legal experts and regulatory bodies. Our trustworthiness is demonstrated through transparent operations, successful case outcomes exceeding $100,000 in recovered funds, and educational initiatives that empower stakeholders across 48 states. As pioneers in autism insurance advocacy, we continue shaping policy through legislative engagement and grassroots community support.
Services
Insurance Appeals Assistance
Regulatory Intervention
Provider Support Services
Educational Seminars
Sliding Scale Fee Programs
Details
- Year established: 2009
Highlights and features
- We have 15+ years of experience in health insurance advocacy
- Our team includes public health experts and education law specialists
- Proven success recovering over $100,000 in denied claims
- We operate with full transparency and no hidden fees
- Our services cover 48 states with legal partnerships nationwide
Services
Insurance Appeals Assistance
We provide comprehensive insurance appeal services for families seeking coverage for autism and mental health treatments. Our team handles first- and second-level appeals with state regulators while leveraging legal partnerships for external reviews. With expertise in federal mental health parity laws, we challenge improper denials related to residential treatment programs, intensive behavioral therapies, and habilitative services. Our success rate exceeds industry standards through strategic documentation review and regulatory intervention.
Regulatory Intervention
Our regulatory intervention services ensure health plans comply with federal and state mental health parity requirements. We file formal complaints with state insurance departments and coordinate with legal teams to address violations. This includes challenging hidden exclusions in plan manuals and advocating for network adequacy improvements. Our interventions have successfully expanded coverage for residential treatment centers and wilderness therapy programs across multiple jurisdictions.
Provider Support Services
We offer end-to-end billing and authorization support for healthcare providers treating autism and mental health conditions. Services include pre-authorization documentation, ongoing utilization review, and claims submission. Our team trains providers on medical necessity documentation to prevent denials while offering contingency-based recovery services for unpaid claims. This comprehensive approach helps providers maintain compliance with evolving insurance requirements while improving reimbursement rates.
Educational Seminars
We conduct educational seminars for families and professionals on navigating insurance systems for autism and mental health coverage. Topics include understanding policy manuals, documenting medical necessity, and challenging improper denials. Our training programs cover both federal and state-specific regulations while providing practical tools for effective advocacy. These sessions empower participants to independently manage insurance interactions while recognizing when to seek professional assistance.
Sliding Scale Fee Programs
Our sliding scale fee structure ensures accessibility to advocacy services regardless of financial circumstances. Fees are determined by family income levels while maintaining high-quality representation through experienced professionals. This program specifically supports low-income families seeking coverage for intensive behavioral therapies, speech therapy, and occupational therapy. The model aligns with our mission to eliminate financial barriers to essential healthcare services for individuals with autism and mental health conditions.
People
Karen Fessel
Founder and Executive Director
Dr. Karen Fessel founded MHAIP after securing services for her son with Asperger's. With a doctorate in public health from UC Berkeley, she previously developed treatment guidelines for Kaiser Permanente and conducted research at UCSF. She co-chaired California's autism insurance subcommittee and serves on national autism advocacy panels.
Lisa Valerio
Treasurer
Lisa Valerio brings 20+ years of marketing operations experience to MHAIP. A former insurance advocate, she volunteers at Community Gatepath and leads technology workshops for autism support groups. Her consulting background in systems implementation enhances the organization's operational efficiency.
LaJoyce Porter
Director
Attorney LaJoyce Porter specializes in education law with a focus on special needs advocacy. A former insurance defense lawyer, she transitioned to education law after identifying her daughters' special needs. She holds a Juris Doctorate from Howard University and advocates for improved educational access through legal channels.
Debra Nelson
Appeals Specialist
Debra Nelson combines policy analysis expertise with lived experience in mental health advocacy. Formerly with the Packard Foundation, she has 15 years of nonprofit board experience and specializes in creative solutions for insurance disputes. Her background includes social impact investing and grantmaking to hundreds of nonprofit organizations.
Marcy Smith
Appeals Specialist
Marcy Smith brings Wall Street finance expertise to insurance advocacy after her family's successful mental health claim settlement. With an MBA from Columbia University, she specializes in analyzing EOB statements and recovering unpaid claims. Her business background enhances the organization's financial accountability and strategic planning.
Questions
What types of insurance plans do you work with?
We work with most private health insurance plans including PPOs, HMOs, and EPOs. Our services cover both fully insured and self-funded plans across 48 states.
How do you help with residential treatment coverage?
We assist with pre-authorization, ongoing utilization review, and appeals for residential treatment centers. Our team helps document medical necessity and challenges improper denials based on federal mental health parity laws.
Do you offer services for autism providers?
Yes, we provide billing support, authorization assistance, and claims recovery services for autism treatment providers including ABA therapists, speech pathologists, and occupational therapists.
What documentation is needed for an appeal?
We require denial letters, medical records, treatment plans, and progress notes. Our specialists review existing documentation and identify gaps that need补充 to strengthen the appeal.
How are your fees structured?
We offer sliding scale hourly rates for families and contingency-based services for large claims. Nonprofits receive discounted rates, and initial consultations are always free of charge.
