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Anybody well versed in healthcare laws?

Posted by on Apr. 8, 2016 at 11:37 AM
  • 10 Replies
1 mom liked this

So my husband has brought up some interesting questions. Autism is still diagnosed under the DSM, indicating that technically it is still considered a mental health disorder, even though overall all Drs, professionals, etc, classify is as a neurobiological disorder. 

Reason I ask is because the Affordable Care Act mandated ALL insurance cover mental health benefits. You can not be denied coverage for a mental health disorder. But Autism CAN BE EXCLUDED from coverage under insurance plans that have been grandfathered in. But if autism is considered mental health, wouldn't that automatically mean it can't be excluded?????

I think my head may explode. I explained to my husband that even if autism were covered under all plans no matter what, if its going to be covered under mental health, ABA, speech and occupational therapies are not considered mental health therapies, therefore those therapies could still be denied coverage even for a covered disorder, right???

I'm going in circles and making my head spin. We're looking at these things up close right now because I'm actually going to go to a town hall meeting where a state representative will be and want to bring questions, and I have many, lol.    Wish me luck and pray for my strength and will power!!! I am normally a very timid and quiet person, this is totally out of my comfort zone but I feel compelled to fight for my child's services!!! I think God may be leading me down a path of advocacy.


Oh and just to give an update to those wondering ...... I apparently did what was needed with the school. They are now going to do all the re-evaluations BEFORE having an IEP meeting for placement. So we'll have two ARDS. One deciding all evals that need to be done, then all evals with be completed before the end of the school year, and have a second ard before school is let out to decide placement. And I'm getting an invitation today to visit the classroom mentioned by the diagnostician when i told her I was invited to see the other classroom but already knew that was not the right place for her.

by on Apr. 8, 2016 at 11:37 AM
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Replies (1-10):
rebecca_new_mom
by Gold Member on Apr. 8, 2016 at 11:43 AM

I am glad you are getting those re-evals done before her IEP! I think you are/will make a great advocate both for your daughter and in the autism community as a whole!

rebecca_new_mom
by Gold Member on Apr. 8, 2016 at 12:28 PM
I will as my husband about the healthcare law tonight. But it's not really his area... www.hjchanglaw.com
Ralgj
by April on Apr. 8, 2016 at 1:29 PM
You're a great advocate!! Will pray for your strength.

SamMom912
by Platinum Member on Apr. 8, 2016 at 1:47 PM
Im SO proud of you!!!
Charizma77
by Carissa on Apr. 8, 2016 at 1:54 PM
I know absolutely nothing about healthcare laws but keep us posted what you find out.

Oh and you rock! Happy for you :)
rebecca_new_mom
by Gold Member on Apr. 8, 2016 at 2:48 PM

Have you tried getting a new healthcare plan, not one that's been grandfathered in? Are you still unable to get the coverage under a brand-new plan per the ACA? That was my husband's only thought based on what you wrote. I'm sorry I can't be of more, real help in this matter.

You are amazing and will do great at this!

ineedcoffeemom
by Brittaney on Apr. 8, 2016 at 3:21 PM
1 mom liked this

We purchased a separate ACA plan for Cheyanne last year. That's how we were able to do a year of ABA. But the plan we were using switched from PPO to HMO rendering it completely useless. Nobody takes HMO in this area, certainly not ABA providers. All the other plans costs twice the amount we were paying for that one, making it not "affordable" for us, considering we can't get any premium discount due to the fact we technically have a qualified plan through my husband's employer. And only 1 of the other options available (that cost twice as much) was accepted by our ABA provider. And her pediatrician's office didn't accept it!!

So after going through two months of extensive research last year into all our insurance options, we decided the best route was to just to put her back on his company's insurance because none of the ACA options were worth it. MAYBE if Cheyanne had made amazing progress in ABA and we couldn't live without it, we'd have been willing to pay the 15000 that insurance would have cost, along with paying our insurance too (because last year we had two separate insurance plans .... so two premiums, two deductibles and two out of pocket maxs). But as I've made just as much progress with her on my own, it just wasn't worth it. They provided me a much needed break but honestly it wasn't the best for her. And we're more trying to push this time because if Cheyanne has apraxia, speech therapy isn't covered either under our grandfathered in plan.

Quoting rebecca_new_mom:

Have you tried getting a new healthcare plan, not one that's been grandfathered in? Are you still unable to get the coverage under a brand-new plan per the ACA? That was my husband's only thought based on what you wrote. I'm sorry I can't be of more, real help in this matter.

You are amazing and will do great at this!


rebecca_new_mom
by Gold Member on Apr. 8, 2016 at 3:28 PM

The whole system right now is a mess. I think just the fact that you are keeping your sanity through all this is an accomplishment Lol! Did you say that Cheyenne will get speech therapy in school? It seems like clearly that needs to be in her IEP.

Quoting ineedcoffeemom:

We purchased a separate ACA plan for Cheyanne last year. That's how we were able to do a year of ABA. But the plan we were using switched from PPO to HMO rendering it completely useless. Nobody takes HMO in this area, certainly not ABA providers. All the other plans costs twice the amount we were paying for that one, making it not "affordable" for us, considering we can't get any premium discount due to the fact we technically have a qualified plan through my husband's employer. And only 1 of the other options available (that cost twice as much) was accepted by our ABA provider. And her pediatrician's office didn't accept it!!

So after going through two months of extensive research last year into all our insurance options, we decided the best route was to just to put her back on his company's insurance because none of the ACA options were worth it. MAYBE if Cheyanne had made amazing progress in ABA and we couldn't live without it, we'd have been willing to pay the 15000 that insurance would have cost, along with paying our insurance too (because last year we had two separate insurance plans .... so two premiums, two deductibles and two out of pocket maxs). But as I've made just as much progress with her on my own, it just wasn't worth it. They provided me a much needed break but honestly it wasn't the best for her. And we're more trying to push this time because if Cheyanne has apraxia, speech therapy isn't covered either under our grandfathered in plan.

Quoting rebecca_new_mom:

Have you tried getting a new healthcare plan, not one that's been grandfathered in? Are you still unable to get the coverage under a brand-new plan per the ACA? That was my husband's only thought based on what you wrote. I'm sorry I can't be of more, real help in this matter.

You are amazing and will do great at this!



ineedcoffeemom
by Brittaney on Apr. 8, 2016 at 3:32 PM

She currently gets 15 mins once a week. So practically nothing.

Quoting rebecca_new_mom:

The whole system right now is a mess. I think just the fact that you are keeping your sanity through all this is an accomplishment Lol! Did you say that Cheyenne will get speech therapy in school? It seems like clearly that needs to be in her IEP.

Quoting ineedcoffeemom:

We purchased a separate ACA plan for Cheyanne last year. That's how we were able to do a year of ABA. But the plan we were using switched from PPO to HMO rendering it completely useless. Nobody takes HMO in this area, certainly not ABA providers. All the other plans costs twice the amount we were paying for that one, making it not "affordable" for us, considering we can't get any premium discount due to the fact we technically have a qualified plan through my husband's employer. And only 1 of the other options available (that cost twice as much) was accepted by our ABA provider. And her pediatrician's office didn't accept it!!

So after going through two months of extensive research last year into all our insurance options, we decided the best route was to just to put her back on his company's insurance because none of the ACA options were worth it. MAYBE if Cheyanne had made amazing progress in ABA and we couldn't live without it, we'd have been willing to pay the 15000 that insurance would have cost, along with paying our insurance too (because last year we had two separate insurance plans .... so two premiums, two deductibles and two out of pocket maxs). But as I've made just as much progress with her on my own, it just wasn't worth it. They provided me a much needed break but honestly it wasn't the best for her. And we're more trying to push this time because if Cheyanne has apraxia, speech therapy isn't covered either under our grandfathered in plan.

Quoting rebecca_new_mom:

Have you tried getting a new healthcare plan, not one that's been grandfathered in? Are you still unable to get the coverage under a brand-new plan per the ACA? That was my husband's only thought based on what you wrote. I'm sorry I can't be of more, real help in this matter.

You are amazing and will do great at this!



rebecca_new_mom
by Gold Member on Apr. 8, 2016 at 3:35 PM

Yep, that's not enough. I hope she gets more speech with the new IEP. She's lucky to have you in her corner to advocate for her!!!

Quoting ineedcoffeemom:

She currently gets 15 mins once a week. So practically nothing.

Quoting rebecca_new_mom:

The whole system right now is a mess. I think just the fact that you are keeping your sanity through all this is an accomplishment Lol! Did you say that Cheyenne will get speech therapy in school? It seems like clearly that needs to be in her IEP.

Quoting ineedcoffeemom:

We purchased a separate ACA plan for Cheyanne last year. That's how we were able to do a year of ABA. But the plan we were using switched from PPO to HMO rendering it completely useless. Nobody takes HMO in this area, certainly not ABA providers. All the other plans costs twice the amount we were paying for that one, making it not "affordable" for us, considering we can't get any premium discount due to the fact we technically have a qualified plan through my husband's employer. And only 1 of the other options available (that cost twice as much) was accepted by our ABA provider. And her pediatrician's office didn't accept it!!

So after going through two months of extensive research last year into all our insurance options, we decided the best route was to just to put her back on his company's insurance because none of the ACA options were worth it. MAYBE if Cheyanne had made amazing progress in ABA and we couldn't live without it, we'd have been willing to pay the 15000 that insurance would have cost, along with paying our insurance too (because last year we had two separate insurance plans .... so two premiums, two deductibles and two out of pocket maxs). But as I've made just as much progress with her on my own, it just wasn't worth it. They provided me a much needed break but honestly it wasn't the best for her. And we're more trying to push this time because if Cheyanne has apraxia, speech therapy isn't covered either under our grandfathered in plan.

Quoting rebecca_new_mom:

Have you tried getting a new healthcare plan, not one that's been grandfathered in? Are you still unable to get the coverage under a brand-new plan per the ACA? That was my husband's only thought based on what you wrote. I'm sorry I can't be of more, real help in this matter.

You are amazing and will do great at this!




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