A Response to Papatola and Lustig’s Paper on Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum
Federal parity law is your best weapon—quote it, show data, and denials flip.
01Research in Context
What this study did
Kornack et al. wrote a reply to Papatola’s 2016 paper on winning insurance peer reviews.
They added legal facts, sample appeal letters, and a checklist you can copy.
The paper is for BCBAs who treat kids with autism and fight denials.
What they found
The authors found that most denials break federal parity law.
They show how to cite that law, attach data, and turn a no into a yes.
How this fits with other research
Papatola et al. (2016) gave the first map for peer-review calls; Kornack keeps the same steps but adds the legal hammer.
Coop et al. (2025) later widened the fight, telling BCBAs to lobby lawmakers, not just insurers.
Kornack et al. (2020) used the same appeal tactics to keep centers open during COVID, proving the tools work beyond insurance.
Why it matters
You can win more authorizations in less time. Keep the one-page parity cheat sheet in your folder. When a reviewer says “no,” read the exact line from Kornack’s script and fax the appeal the same day.
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02At a glance
03Original abstract
In their 2016 article, “Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis [ABA] in the Treatment of Children on the Autism Spectrum,” Papatola and Lustig provide an overview of the managed care process, discuss the medical necessity of ABA, and offer guidance to clinicians on how to navigate the managed care peer review process. Given that the authors are employed by a large international health insurance carrier and conduct peer reviews on behalf of that organization, this response seeks to provide guidance from both the clinical and public policy perspectives that reflect best practices in the field of autism treatment. This response is not written with the intention of providing or replacing legal advice; rather, this paper offers health care providers of ABA an essential understanding of some of the laws that govern and support their efforts to secure medically necessary treatment and the mechanisms in place with which to challenge decisions by managed care organizations, health plans, and health insurance issuers that may be contrary to best practices. Finally, suggestions are offered on how to navigate a peer review to ensure optimal outcomes and, when necessary, to lay the groundwork to overturn a funding source decision that does not reflect best practices or the standard of care in ABA-based autism treatment.
Behavior Analysis in Practice, 2017 · doi:10.1007/s40617-017-0192-x