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What kind of services are covered under private health insurance AND/OR Medicaid waiver for patients who are children with Autism?

I'm having problems with getting my son evaluated. We get health insurance through my husband's employer. The insurance call the specialist and told her to abstain from performing my son's neuropsychological evaluation because patients with Autism aren't covered for this kind of benefit. I'm getting sick of this. I don't know what t do????


Asked by Anonymous at 11:00 AM on Jun. 5, 2011 in Kids' Health

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Answers (2)
  • My son has autism, and my insurance does cover his therapy visits at 80%, and they also cover his meds. In his case he is seeing a mental health therapist and she does not bill it out as 'autism' it is billed out under a 'mental health' DSM code due to him seeing the therapist for anger issues, behavior issues and such.   Some of it could depend on your plan provisions, or the date you started that insurance. Sometimes 'new' insurances won't cover autism as they consider it "pre-existing". I would advise calling your insurance company and asking them about your plan, and what will they cover under autism.  If you are a member of one of the Autism groups on CM you could post there as well and ask them about their experiences with autism/insurances.  Good luck!


    Answer by MizLee at 3:15 PM on Jun. 5, 2011

  • Usually when you have a private insurance and then Medicaid the private Ins. covers 80% and then the medicaid will pick up the rest. I would try Autism websites and start talking to some moms here who have a child with autism. Join one of the groups.

    Answer by RedDahlia82 at 11:07 AM on Jun. 5, 2011