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Can you tell me about autism and health insurance? Do you think healthcare reform would help or hurt benifits?

Health Care Insurance For Autistic People – Compare Rates And Quotes For Coverage From American Family Insurance, State Farm And Nationwide
March 24, 2011

The Obama Health Reform Act was passed in 2010 but many parts of the legislation will not go into effect until 2014. Many Families have been denied coverage based on pre-existing conditions. The Health Reform Act has been written to prevent health insurance companies from denying coverage based on conditions such as autism.
Families with autistic children often have difficulty in obtaining health insurance coverage for that child. Unfortunately, many insurance companies will issue a decline based on autism. Autistic children need a lot of health insurance coverage, and many companies see ensuring an autistic child as too risky.

When looking for health insurance policies for an autistic child, it is good to remember that some health insurance plans will cover therapy for loss of function, but do not necessarily deem an autistic child as having lost any functions. Reading the fine print and getting familiar with the health insurance policy is crucial.

Roughly half of the United States are mandated to cover autism. Unfortunately many states still do not cover autistic children. There are many options for health insurance coverage of autistic children. These are state high-risk pools, children of families with moderate incomes, Medicare for autistic individual(that isn’t always successful), and group health insurance.

Researching multiple health insurance providers, and getting great quote, and understanding what the health care policy covers is the best way for families of autistic children to get a good health care plan for their autistic child.

I am not about to pretend to know what i is like to have an autistic child - just want to know what you think of this.

Answer Question

Asked by emilysmom1966 at 1:15 PM on Apr. 3, 2011 in Politics & Current Events

Level 18 (6,228 Credits)
Answers (15)
  • My son's autism has had no impact at all on our health insurance. But he gets no services through our health coverage, only through the school.

    Answer by gdiamante at 1:17 PM on Apr. 3, 2011

  • How so , through the school?

    Comment by emilysmom1966 (original poster) at 1:19 PM on Apr. 3, 2011

  • my daughter has private insurance
    it paid for a PhD to see her five times to give autism report
    then paid for ZERO

    on autism waiver through county/state/ and federal - trickles down
    listing list is year and a half long

    ANYTHING would be better than ZERO

    gets therapy through school, but not for autism, she of course gets speech, OT, PT and special ed = but no autism therapy
    IEP through public school, none in summer of course

    Answer by fiatpax at 1:29 PM on Apr. 3, 2011

  • listing list is year and a half long

    meant ..... waiting list

    Answer by fiatpax at 1:31 PM on Apr. 3, 2011

  • We have both private and state reimbursed insurance plans--the latter BECAUSE of their diagnosis. BCBS pays for 60 speech therapy sessions/year; Gateway (state reimbursed), pays 100% of their 6-week summer day camp tuitions (KIdsPeace/Sarah's Smile), annual Developmental Pediatrician appointments, the outstanding balance on whatever our private insurance doesn't cover, and a social skills development group. We pay out of pocket for the Relationship Development Intervention program--which costs us a little over $10,000 per year for both children (it was double that when we first started the program). We also get an annual Autism Mini Grant, which pays for therapeutic horseback riding lessons. Fortunately we have the financial resources to be able to pay out of pocket for services that are not covered. And we have NOT taken advantage of a number of programs that PA offers--such as Therapeutic Support Staff (TSS).

    Answer by LoriKeet at 2:37 PM on Apr. 3, 2011

  • UNFORTUNATELY, "Act 62" (tied to ObamaCare) was SUPPOSED to cover ALL services related to autism, but it has YET to actually materialize. The ONLY promise I was hoping Obama would actually keep....and he has YET to see through.

    We've never been the types to "wait and see," and we've managed to find the resources to pay for our children's needs. It would however, be nice for the millions of other parents faced with autistic children to be able to give their children every possible advantage to maximize their development without tons of red tape or having to front the money in the HOPES the money is reimbursed in a timely manner!!

    I have watched two friends lose their HOMES paying for treatments out of pocket, and a number of others divorce. I count myself among the lucky ones.

    Answer by LoriKeet at 2:42 PM on Apr. 3, 2011

  • How so , through the school?

    With a diagnosis, public schools are REQUIRED to provide a "free and appropriate education in the least restrictive environment" while addressing the specific needs of the students. This results in an Individualize Education Plan (IEP) or "504 Plan" (behavior based). As part of the IEP/504 school will provide speech and occupational therapies during school hours, learning support/resource room time, special testing requirements/accommodations, and even specialized classroom placement (autistic support classrooms), with teachers and aides specially trained/educated in autism.

    Answer by LoriKeet at 2:45 PM on Apr. 3, 2011

  • Since schools are required to provide a lot of therapy and special services, I don't know how much a medical insurance should cover. I think it would depend on the severity of the autism and what the child's needs are. My son doesn't have medical issues from his autism, but he might benefit from behavioral therapy. But if insurance companies are required to provide ALL therapies and services, it will either raise prices for everyone or lower benefits for other people. Insurance companies have to stay above bancruptcy too, they're businesses too.
    As far as government healthcare providing benefits for Autism, it should still be dependent on the child and the child's needs. Otherwise there will be people demanding therapies and services that aren't necessary, just because they're available and they don't have to pay for it.

    Answer by Laura2U at 3:35 PM on Apr. 3, 2011

  • Since schools are required to provide a lot of therapy and special services, I don't know how much a medical insurance should cover.

    My son's school only gives him (severely speech delayed) 1 hour of speech therapy a week and that's in 15 minute incriments. Those 15 minutes includes walking to a nd from her office from his room so if he's lucky he gets 9 or 10 minute sessions. Sorry but the schools are not giving these kids enough nor can they afford to.

    Answer by trippyhippy at 4:56 PM on Apr. 3, 2011

  • Schools may be required to provide help, but quality isn't always that good. I have a friend that gave up a well paying job to homeschool her child. I feel we have been fortunate with our school program. It's budget is taking a big cut this spite of causing the school to get in trouble with the feds.

    I don't think ins co's should be able to limit services because a school provides. When my son started preschool in OK he only received 1 speech and 1 OT session a week. That was a drop in the bucket. Our ins paid for 3 of ea per week and my dh and I paid for 2 more or ea per week for almost a yr.

    My child has had INTENSIVE therapies..some pd by sch, some by us and some by ins. More therapy = a better outcome. Our child is on the cusp of being considered Recovered..a very rare thing.

    Answer by yourspecialkid at 4:57 PM on Apr. 3, 2011

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