Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

Autism - Support Across the Spectrum Autism - Support Across the Spectrum

Insurance Coverage

Posted by on Feb. 18, 2013 at 8:12 PM
  • 31 Replies

What kind of health insurance do you have?  Does it cover all the expenses for your child?

by on Feb. 18, 2013 at 8:12 PM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-10):
Bobsie
by Bronze Member on Feb. 18, 2013 at 9:28 PM
None in utah
Posted on the NEW CafeMom Mobile
LaurieMomof4
by on Feb. 18, 2013 at 9:48 PM

In California the laws changed last year, they have to cover Autism treatments as part of a PPO now. We have Anthem Blue Cross and it will be covering all of our son's ABA.

JTMOM422
by Brenda on Feb. 18, 2013 at 10:52 PM
We are military so we are covered by Tricare. They pay for 100% of ds speech and ot. They also pay for his ABA therapist. We pay out of pocket $35 a month. What we pay is based off of my husbands rank.
KatyTylersMom
by on Feb. 18, 2013 at 10:58 PM

HAHAHAHAHAHAHAHAHA oh that's funny - insurance actually covering things our kids need... yeah no.  We also live in California and unless your insurance plan is a fully-funded plan (which many PPO's are NOT) then they are NOT required by law to cover ABA.  We pitched a HUGE fit to our employer who then took our case to the parent company and so as of this January we now have EQUAL coverage with our expensive PPO plan to the shitty HMO plan.  Great right?  Wrong.  Now for ABA we pay the mental health co-pay for EVERY SINGLE SESSION.  For those of you playing along at home, that's $35, 5x a week, 52 weeks a year, or roughly $8,000 IN CO-PAYSI don't know about you guys but that puts a serious hurt on our finances.

Then you have to figure that hey the kid doesn't talk, maybe he needs speech therapy!  And PT and OT!  Oh well, 2x a week of speech, 1x a week of OT and PT, well hey that's another $35 co-pay each session for a grand total of NINE co-pays of $35 a week or $16,380 a year in co-pays not counting any doctors' visits or hell anything for us parents or our other autistic child (yeah that's right, that's $16k for ONE KID).  And better yet, our PPO does NOT allow any co-payments to be applied to our out-of-pocket maximum.  SORRY TOO BAD! 

On top of all that insult, our speech therapist (wisely) does not participate with any insurance.  Not a problem you think because hey, we have a PPO and the idea there is to be able to go OUT of plan to see the doctors and professionals you feel suit you best.  Right?  SURE!  They give you a nicely itemized bill, complete with all the correct CPT codes, diagnosis codes, everything signed and just as it should be.  You get your claim form online, fill it out, mail it in, and think GREAT in a week or two we'll be getting paid back by the insurance company right?  Nope sorry they lost your claim.  Yes they have a record of receiving it but no they can't find it could you please send it again?  Sure.  B/c you were smart you xeroxed the bill so you send it again.  Oh sorry we couldn't process it as the provider wasn't in our plan.  Yes, we know, they're out of plan hence we are submitting the bill.  OH SO SORRY could you please resubmit the bill again?  Yup... oh look yet another denial, this time because it's a DUPLICATE of a claim you've already submitted... yes but I was told to resubmit? OH SO SORRY our mistake, could you please resubmit AGAIN?  But why - you have the bill right there... OH YES SORRY AGAIN we'll send it for reprocessing... That can take up to 15 business days so call back after that time has elapsed.  Meanwhile 2 months has already elapsed, and you've probably submitted two more months of bills for which you are now in the hole hundreds of dollars, and the best part is - THEY'LL DO IT ALL AGAIN EVERY SINGLE MONTH. 

So my advice: do not EVER EVER EVER get Cigna as your health insurer, and if you do make sure you keep STRICT notes on when you submitted, have copies of every bill, and get a "customer care specialist" that you can email day or night who will work with you to find out what has happened to your claim THIS TIME (b/c they like to get creative in their screw ups) so that one day, 6 months later, you might actually get your money. 

supermomz25
by on Feb. 18, 2013 at 11:02 PM

we have Kaiser and they cover pretty well.

shugerbit
by Member on Feb. 18, 2013 at 11:11 PM

none here in mass on our ppo even with the arica law. but with the autism diagnosis he gets supplemental Medicaid because it is a disability. he is also under 3 so the state picks up all st, ot, and aba that they wont pay for. i am scared how drastically it may change once he turns 3.


MommaHubbard
by on Feb. 18, 2013 at 11:13 PM

We have the same but I pay $30 a month.


Quoting JTMOM422:

We are military so we are covered by Tricare. They pay for 100% of ds speech and ot. They also pay for his ABA therapist. We pay out of pocket $35 a month. What we pay is based off of my husbands rank.



LaurieMomof4
by on Feb. 19, 2013 at 12:19 AM


I am so sorry you are going through this :( We will have to pay a $15 copayment for ABA 7x a week, 52 weeks... We are just going to put it through medical reimbursement so that it's pretax income. As for the insurance company losing your bills, that's just what they do... They try to procrastinate paying as much as possible. My husband knocked out 3 teeth in a medical emergency he was then hospitalized for. Per our policy the dental work should have clearly been 80% covered. It took us a year and a half and 5 appeals but we finally got $16,000 back that we had to come up with to pay for dental implants. They all suck, it's a horrible system.

Quoting KatyTylersMom:

HAHAHAHAHAHAHAHAHA oh that's funny - insurance actually covering things our kids need... yeah no.  We also live in California and unless your insurance plan is a fully-funded plan (which many PPO's are NOT) then they are NOT required by law to cover ABA.  We pitched a HUGE fit to our employer who then took our case to the parent company and so as of this January we now have EQUAL coverage with our expensive PPO plan to the shitty HMO plan.  Great right?  Wrong.  Now for ABA we pay the mental health co-pay for EVERY SINGLE SESSION.  For those of you playing along at home, that's $35, 5x a week, 52 weeks a year, or roughly $8,000 IN CO-PAYSI don't know about you guys but that puts a serious hurt on our finances.

Then you have to figure that hey the kid doesn't talk, maybe he needs speech therapy!  And PT and OT!  Oh well, 2x a week of speech, 1x a week of OT and PT, well hey that's another $35 co-pay each session for a grand total of NINE co-pays of $35 a week or $16,380 a year in co-pays not counting any doctors' visits or hell anything for us parents or our other autistic child (yeah that's right, that's $16k for ONE KID).  And better yet, our PPO does NOT allow any co-payments to be applied to our out-of-pocket maximum.  SORRY TOO BAD! 

On top of all that insult, our speech therapist (wisely) does not participate with any insurance.  Not a problem you think because hey, we have a PPO and the idea there is to be able to go OUT of plan to see the doctors and professionals you feel suit you best.  Right?  SURE!  They give you a nicely itemized bill, complete with all the correct CPT codes, diagnosis codes, everything signed and just as it should be.  You get your claim form online, fill it out, mail it in, and think GREAT in a week or two we'll be getting paid back by the insurance company right?  Nope sorry they lost your claim.  Yes they have a record of receiving it but no they can't find it could you please send it again?  Sure.  B/c you were smart you xeroxed the bill so you send it again.  Oh sorry we couldn't process it as the provider wasn't in our plan.  Yes, we know, they're out of plan hence we are submitting the bill.  OH SO SORRY could you please resubmit the bill again?  Yup... oh look yet another denial, this time because it's a DUPLICATE of a claim you've already submitted... yes but I was told to resubmit? OH SO SORRY our mistake, could you please resubmit AGAIN?  But why - you have the bill right there... OH YES SORRY AGAIN we'll send it for reprocessing... That can take up to 15 business days so call back after that time has elapsed.  Meanwhile 2 months has already elapsed, and you've probably submitted two more months of bills for which you are now in the hole hundreds of dollars, and the best part is - THEY'LL DO IT ALL AGAIN EVERY SINGLE MONTH. 

So my advice: do not EVER EVER EVER get Cigna as your health insurer, and if you do make sure you keep STRICT notes on when you submitted, have copies of every bill, and get a "customer care specialist" that you can email day or night who will work with you to find out what has happened to your claim THIS TIME (b/c they like to get creative in their screw ups) so that one day, 6 months later, you might actually get your money. 



darbyakeep45
by Darby on Feb. 19, 2013 at 6:32 AM

Glad to hear that...that's wonderful!

Quoting LaurieMomof4:

In California the laws changed last year, they have to cover Autism treatments as part of a PPO now. We have Anthem Blue Cross and it will be covering all of our son's ABA.


darbyakeep45
by Darby on Feb. 19, 2013 at 6:33 AM
1 mom liked this

Yep, same here.  My son has ECHO and they cover 100% of his therapies including his ABA.  Once he turns 6 years old, he will be attending a private Autism school, and ECHO will pay for that as well:)  It's a wonderful thing and I'm happy about it for sure!  

Quoting JTMOM422:

We are military so we are covered by Tricare. They pay for 100% of ds speech and ot. They also pay for his ABA therapist. We pay out of pocket $35 a month. What we pay is based off of my husbands rank.


Add your quick reply below:
You must be a member to reply to this post.
Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

close Join now to connect to
other members!
Connect with Facebook or Sign Up Using Email

Already Joined? LOG IN