Autism Health Insurance
Reach Out to Children with Autism
Coverage for autism treatments is still far from common, but it is improving. Some large employers offer policies that cover treatment, and 15 states have passed laws mandating at least some autism health insurance coverage. In addition, Maine and New Hampshire both have legislation pending that could pass soon. But as for why autism isn’t covered in the first place, the industry insists that behavioral therapy is an educational measure, not a medical one, and therefore not its bailiwick.
If you do have coverage, watch for limitations. Because treatment for autism is so individualized, there are few uniform standards or protocols for insurance companies to follow. That means parents often have to argue that a certain therapy or treatment is necessary. Also, be sure to check any caps on treatment, Mr. Sell warns. What may look generous — say $36,000 a year — can be spent quickly. Or there may be limits on how many sessions of a particular type of therapy will be paid for each year.
It’s not like you read your insurance policy and you can see a specific exclusion. You can submit bills, and you may get denials back that said ‘experimental… denied,’ or ‘provided by a non-licensed provider… denied.’ Or sometimes the insurance companies would say ‘this therapy is educational in nature, not medical… denied.’”
And you will want to coordinate your autism health insurance coverage with the services you may be receiving from your child’s school. If an occupational therapist sees your child regularly in school, for example, you may want to save your insurance dollars for social interaction therapies.
In addition, you may need to be especially aggressive about health insurance coverage for some medical conditions. Gastrointestinal problems, for instance, are extremely common in autistic children.
