If your appeal stalls, leverage local organizations for backup:
• Kentucky Department of Insurance (DOI): If you hold a fully insured plan, you can file an official consumer complaint regarding unfair claim practices directly via the Kentucky DOI Consumer Protection Division.
• FEAT (Families for Effective Autism Treatment) of Louisville: This local non-profit provides support networks, education resources, and navigating assistance for families facing autism service gaps.
• Kentucky Protection & Advocacy (P&A): A state-designated advocacy agency that helps individuals with developmental disabilities fight systemic insurance or Medicaid service barriers

1. Determine Your Plan Type and Deadlines
The rules governing your appeal depend entirely on how your health coverage is structured. Call your insurance member services or talk to your employer’s HR benefits contact to find out which category you fall under:
• Kentucky Fully-Insured Plans: Regulated by state laws, including Kentucky's autism mandate.
• Self-Funded Employer Plans: Regulated by federal ERISA laws and the Mental Health Parity and Addiction Equity Act (MHPAEA).
• Kentucky Medicaid (e.g., Passport, Anthem, WellCare, Humana Healthy Horizons): Follows strict federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidelines. Medicaid timelines are much shorter than commercial plans.
Note the clock immediately: Commercial plans typically grant 180 days from the date of the denial letter to file an internal appeal.
2. Identify the Exact Denial Reason

3. Collaborate With Your ABA Provider

4. File the Internal Appeal

5. Escalate to an External Review