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Autism and insurance

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Old 04-08-2011, 10:23 AM   #1
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Silas1066 HB User
Autism and insurance

I am wondering if anyone else here is going through the same thing I am with autism and insurance.

I have 2 boys: one has Asperger's and the other PDD-NOS. They require Applied Behvioral Analysis (recommended by both their pediatrician and independent analysts) and OT.

In my last 2 jobs, my employer has implemented a "self-insured" health benefit for the employees: this means that even though state law requires insurance companies provide an ABA and OT benefit for autistic children, the self-insured plans don't have to abide by this. The consequence of this, is my kids get ABSOLUTELY NO autism benefit or treatment. I have to pay for everything out of pocket, and I can't even use a HSA.

The school district will not provide ABA, and will only give 1 hour a week individual help for my son with PDD-NOS.

I currently spend almost $1000 a month on my kids' care.

So the question is this:

1. With Obamacare, will the insurance companies have to provide a minimum amount of autism coverage? Or will this continue like it is, where people in self-insured plans (almost 40% of companies have these) will be chronically underinsured.

2. Do I have any other options at all, or am I just out of luck? I can't change jobs right now--and even if I did, I would likely end up in another self-insured plan.

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Old 04-13-2011, 07:24 AM   #2
Join Date: Apr 2011
Location: USA
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Suzanne44 HB UserSuzanne44 HB User
Re: Autism and insurance

The self insured policy you are describing sounds awful and frustrating. If your ped. and an outside consultant are both reccommending ABA, it might be worth your while to have a consultation with a special needs attorney to see what can be done, especially with the school district providing more ABA and possibly your insurance company. I wish you good luck.

Old 04-13-2011, 07:47 PM   #3
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Re: Autism and insurance

If you have not done so already , call your local regional center. They might be able to help. Regional Centers pay for specialized services , and in home programs, when necessary. The only thing that i am unsure of is if they would for for children who have the Asperger's , and PPD-nos diagnoses. You would have to ask them about that.

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