Insurance Agrees To Cover Princeton Teen's $465K Autism Treatment

Princeton, NJ -- A Princeton family who was asking the public for help in getting their son admitted to a Baltimore-based hospital to help with his autism will have his son covered by their insurance company after all, according to the family’s attorney Jodi Bouer.

“After four days of non-stop work on my and Laura's part, with the help of a New Jersey Legislator and the New Jersey Dept. of Banking and Insurance, we convinced the insurer to cover the services,” Bouer told Patch in an email. “Of course, there is a very real specter of the insurer denying coverage long before the child’s services are completed and he is discharged (it is a 5-6 month intensive inpatient treatment program), the family has very high coinsurance obligations.”

Laura Morgan’s friend also set up a GoFundMe drive to help the family cover the $465,000 cost for a 4-6 month stay at Baltimore-based Kennedy Krieger Institute’s Neurobehavioral Unit for her 14-year-old son Jackson.

The fundraiser reached $52,142 and is now closed.

“To get my child admitted to KKI today, I signed an agreement with KKI where I agreed to pay any uncovered expenses,” Morgan said in the post, adding that if any money is left over from the fundraiser, the family will donate it to an autism-related charity to help other kids like Jackson get the help they need.

Jackson suffers from what Morgan describes as “extreme self injurious behavior, aggression and property destruction on an hourly basis.” Jackson had lost weight and been hospitalized several times.

KKI has a track record of reducing this behavior by about 80 percent, Morgan said.

The average four-month stay costs about $465,000. Even with insurance coverage in place, Morgan could be responsible for hundreds of thousands of dollars in the likely event the insurer later denies coverage or the some of Jackson’s services are covered on an out of network basis.

Morgan’s insurer initially said it would cover the costs for the stay but then could not come to an agreement with the facility on payment. The insurer then retracted its offer and tried to send their son to a facility that was inappropriate, and could not meet his needs.

The family hired Bouer on Monday of last week.

“For the last 4 days she been working nonstop with us to convince our insurer to honor its coverage obligation and get Jackson admitted to KKI,” Morgan said in the post. “She marshalled our legal arguments and medical opinions, and enlisted legislators and the New Jersey Department of Banking and Insurance (DOBI) to compel insurer to cover Jackson’s treatment at KKI. Because of Jodi’s hard work and network of relationships, she secured the support of State Senator Joe Vitale, chairman of the Senate Health, Human Services and Senior Citizens Committee, and DOBI.”

Eventually, the insurance company agreed to cover Jackson, and he has been admitted to KKI.

“We cannot thank Senator Vitale’s office, and DOBI Commissioner Richard Badolato and his team at DOBI enough for taking on Jackson’s cause, lending their critical support, and proving that people are more important than politics,” Morgan said. “We are thrilled and humbled by the fact that so many people have donated to Jackson’s GoFundMe page. … Our family cannot thank you enough for sustaining our hope and spirits through Jackson’s long battle.”