Many that I have heard about deny to cover anything. (Is this just a tactic, or are there only specific insurance companies that cover anything?

My insurance company-blue shield of Ca hmo -paid for speech therapy for my son. I have been very happy with all of the services they have provided. I think in the state of Ca insurance companies are required to provide services for autistic children. My son is receiving other services -(OT) through the regional center. He is only 22 mos so he still qualifies for EI programs.

Kathy

I would check with your state's Insurance Board to see if there's an Autism mandate for insurance companies. Here in Indiana, if you work for a company that has its headquarters in Indiana, the company's insurance is required to cover autism-related expenses unless the insurance is "self-funded" (i.e. if the company you work for is considered your insurance provider rather than Anthem, Cigna, etc.) My husband works for a company in Indiana, but the company's headquarters are in Florida, so we are covered only if Florida has an insurance mandate for autism. If you aren't covered by a group insurance policy and have private insurance, I believe that the company is required to offer additional coverage for autism.

My Insurance refuses to cover anything. They consiter this a mental health issue, and they don't cover mental health. I spent so long argueing with them that this is a NEUROLOGICAL issue, not mental health, but they won't budge. I have Blue Preffered. (Yeah preffered by who?)

My husband works for a fortune 500 company and they have had Cigna PPO which is really great insurance, but it is only administered by Cigna. His company makes the decisions as a "self funded" plan. They paid without question for 3 years of OT and ST, but as of January this year they said "Oops we shouldn't have been paying for that and now we won't." I argued and researched all the way to the Stae Board of Insurance and the Employment Commission- no good. During that time I paid an out of pocket rate to my therapists office and tried to hang in there, but it was too much of a drain financially. Funny thing is, the therapy office continued to bill the insurance company and after the first few denials, they started paying again. I know that it's just a matter of time before they figure out that they let me "slip through" the cracks again and then they COULD request the doctors office to refund they money. So I don't feel like pushing my luck and now my son only gets what therapy the school offers. I hate insurance companies!

I am on both sides of this issue. My daughter is pdd-nos, and we have fought both the insurance company and the school district in trying to get appropriate services. We also have forked over a lot of money of our own to get private services. Unfortunately, because of a rather extended period of unemployment, we cannot afford a private solution anymore, so we have really pushed for services from our school district. Keeping great records and being able to demonstrate that their methods have not worked while ours have worked went a long way toward finally getting better services this year, and better trained teachers as well. Unfortunately, now it looks like we are going to have to move away because companies around here like to post jobs forever without ever hiring.

As a health insurance actuary, primarily working with individual products, I understand the costs to the insurance company that get passed on to the policyholders, who then choose not to buy insurance, which then increases the cost to the remaining policyholders, etc. etc. Meanwhile, other insurers that aren't covering it are able to stay in business. Face it, if people don't have someone in their family with autism, they are not going to want to shell out more money to insure against it. This is an after-the-fact item. Until we can get autism awareness up to the point where the general public wants coverage for autism BEFORE someone in the family is diagnosed with a spectrum disorder, insurance is not the answer.

My view is that insurance should cover the diagnosis costs up to a point where the degree of the disability is somewhat understood, and then the larger tax base should take over by requiring full funding for the IDEA. Insurance companies should not be expected to foot this entire bill. There is no real "cure", and it would make medical insurance even more unaffordable than it already is.

jskab, I understand what you're saying about insurance not being the answer and that there needs to be some other form of relief for our families. Full funding of IDEA would be great as long as the schools then used the money to make sure their is enough adequately trained personnel to do the job that needs to be done. I've also seen some ideas thrown around about a tax credit for families dealing with this.

But, playing devil's advocate- There's no real "cure" for other things insurance pays for:
"Chronic obstructive pulmonary disease has traditionally been considered incurable and progressive. However, new treatment options may improve quality of life and extend survival. Chronic obstructive pulmonary disease (COPD) comprises a mixed group of common respiratory diseases united by the presence of persistent airflow limitation, arising usually after many years of tobacco smoking. This regrettably common and largely avoidable disease affects at least 6% of men and 3% of women (1) and is the fourth most common cause of death in the United States today. It is the only common cause of death still increasing in prevalence."

My insurance would cover treatment for COPD if I had it, even if I helped to cause it myslef by smoking and despite the fact that I will still probably die. But they pay for services all the time to improve "quality of life". I can bet my insurance premium is helping some one have a better quality of life, why can't it help my son's quality of life?

I understand what you are saying. And you're right, premiums are pretty high already. But I know people who are on Medicaid and Foodstamps who can get treatment paid for by MY tax dollar and I just can't believe that people who are paying for insurance can't get the kind of coverage for their kids that an unemployed mother of 6 can. Now that's ridiculous.

You Will See Them Wheeling Their Oxygen Tanks (or Others Pushing Them In The Their Wheelchair) In The Hospital So They Can Go Outside & Smoke, Then Call An Emergency Because "surprise, Surprise," They Can't Breathe
Because Their
"copd" Is Incurable (you Can't Regrow Lung Tissue) Yet Insurance Sends Them To Rehab To Train Them How To Recruit The Rest Of The Lung Better To Help Them Breathe, Yet Most Don't Put What They Have Learned Into Practice And/or Stop Smoking (which Caused The Problem For Most Emphysema People In The First Place ) And Are The Vast Majority Of People Who Fill Up Emergency Rooms & Hospital Beds (for Symptoms That Are Avoidable In Most Cases Like Staying With A Few Lifestyle Changes, But Don't Because They Know They Have The Safety Net
That People With Autism Don't Have

Now Back To Autism
I Don't Understand Why Insurance Companies & Schools Aren't Giving "appropriate Education" Which Is Federally Required For All Children?

Autism is not a popular condition, and more and more, it is being considered genetic. With that being the public's perception, if they don't have autism in their family history, people won't want the coverage. It's not like diabetes that you can acquire after the fact. You don't acquire autism. That is one of the things that makes insuring it so unlikely. I can just hear someone saying, "I don't want to have to pay for that coverage. I'll never need to use it." If people in general don't want the coverage, the ones paying the brunt of the insurance costs will be the parents of the autistic kids, but we pay for the services now, anyway. We need more fact-based clinical studies, to get better documented evidence about the root causes and best treatment methods. Also, these studies can't be tainted by people who already have the result they want before they even do the studies.

If autism were covered by insurance, I would want ABA to be the primary method covered. Someone else would want to use other methods of therapy, and still others would want chelation or dietary interventions to be part of what's covered. How do you define what should be covered? This is what I'm getting at by there being no cure. There is not even a standard treatment method. This makes it nearly impossible to insure fairly.

You Are Correct.
But With That Said. There Seems To Be A Genetic Component WITH MANY ASTHMATICS (ALSO COPD), YET THERE ARE MANY DIFFERENT TreatmentS AND EXPENSIVE EMERGENCY ROOM AND HOSPITAL STAYS AND STILL NO Cure FOR That Either.

Based on my son's level of disability he receives Social security and state insurance as a backup to the family insurance. 99% of the time the state insurance covers everything the reg. insurance doesn't and then some, like over counter meds like tylenol & benadryl. It aslo cover 180 pull ups a month since Paul is not potty trained.

Any insurance that offers you mental health benefits will do. I have had about 4 different carriers over the 10 year course and they all have had mental health benefits. It just depends ont eh plan. you can ask your benefits coordinator to set you up on one that allows that if there is a choice. All HMO's will cover based on recommendation from your Primary Care physician. A PPO will allow you but stick with your network so you can get the most out of your benefit.
I have been with BCBS TEXAS
One Health PPO
BCBS Minnesota
Benefit Planners PPO
All have been very good with our claims!

Off Kilter, If you don't mind me asking, how severe is your child's condition? What are the challenges he and your family face on a daily basis? What is his age? Im asking because the SS here (NC) denies everyone I know that has applied (at least 20). They said that the severity now didn't matter because all the children need to reach adulthood before they can say they really need extra financial support. They said that right now it is the parents responsibility to take care of these financial things and when they are an adult and can not hold a job then they would step in to cover expences. Please let me know for the sake of the parents in my Autism support group who struggle daily to get the help they need.

There are two parts to a child ( under 18) receiving SSI. He has to qualify by severity of disability and the parent has to qualify financially. Alot of my son's friends are as severe as Paul but the family income is to high. Once a child reaches 18 even if he or she lives at home the whole ballgame changes and the parents income no longer counts. That is a simple overview. We were a two income family untill Paul was born. I tried to go back to work after he was born but had to give up when it was obvious he had a disability. he was diagnosed when he was under a year old. At first I applyed for SSI for him and was denied, although he qualified medically ( based on severity) and our family income was low enough, we had too much in assets ( money in the bank) to qualify. We had to have very low money we could access. ( under $2000) They have a formula they use to take into account things like cars,house ownership, etc. by the time Paul was 2 we had spent down(used up ) most of our assests so I reapplied. Paul qualified medically, our income was low enough & our assests were under the limit. Paul is 7&1/2 now . SSI disability provides excellent insurance coverage for Paul even covering 180 pullups a month ( for those he had to be not potty train due to disability and over age 3) . the maxium check he could receive is around $700 a month, with children the amount varies based on parents income. You could get a check for as low as $10 depending on income but the child still gets free insurance coverage. On the positive side Paul gets a check each month to help meet his needs and good free insurance. On the negative side we have no savings, any attempt to save money over the asset limit would cause Paul to lose SSI despite severity of his disability. Any raise at work for my husband threatens our financial eligibility. The criteria for disability with some adjustment for childs age is such that were he or she an adult would they be unable to earn each month the maxium SSI amt. of $700. Paul in nonverble and does not respond to simple commands like open your mouth. Paul can not identify body parts,colors,numbers,or letters. He requires one on one supervision at all times as he has no sense of danger and will eat everything. Even yesterday I had to put in a emergency call to our Dr.s office as Paul had removed his surgical dressing from a hernia repair Thur. and eaten them. Paul does not dress himself, bath himself, he thinks CaCa in his pullup is playdough. Paul is severe, there was and still is not question of his qualifying medically based on his disability. Our cath 22 is trying to stay under financial limits to receive services while figuring out a way to save for our future. For Families who are just over the limit for income my heart goes out to them, You either have to be poor enough for SSI or independently wealthy to not need it to survive. I hope this helps ask away if I can help at all.

We have Scott and White. They cover her OT and SLT and horse therapy. However, they won't cover ABA because they have an autism clinic that overs TEACHH. She can only go to TEACHH 30 minutes once a month, but they say that it still counts as an in-service provider. So, we are paying for her ABA.

We also can't get a grant that MHMR gives to people for in-home services because Scott and White claims that they provide the same type of therapy as ABA.