Did you know many autism-related therapies and treatments are not covered by health insurance carriers? Or that some insurers consider autism to be a "pre-existing condition"?
Yep, that's right. Much like the rest of our healthcare system, autism insurance is in great need of reform!
This week in Special Needs Living, CafeMom aurorabunny, mom to 3-year old Brody, who has autism, discusses her hopes for Autism Insurance Reform in 2010.
A new year and a new hope for Autism Insurance Reform
by aurorabunny
I can remember that at exactly this time last year, my husband and I were both very excited and nervous to hear that a bill suggesting autism insurance reform was to be introduced in our state. The aforementioned bill would have made it mandatory for insurance companies to provide coverage for autism diagnosis and treatment. Much to our sadness, this bill was sent back before it was able to hit the House floor for debate, and we had to console ourselves with yet another, "Maybe next year..."
"Next year" came around quickly and here we are again, wondering if another bill will be introduced here in Missouri and hoping that the next one might make it into law. In the past two years, six states — Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana — passed laws requiring coverage of therapies for children with autism, and several other states passed such laws much earlier on.
We personally pay quite a bit to a private insurance company for our coverage and when Brody was first diagnosed with autism, I had to fight them tooth and nail over EVERYTHING. Since he has started school, they have started approving more and more claims for his therapies and have become much more accommodating. I'm very thankful for this even if I don't have any reason as to why the change occurred.
However, I see the flip side of the situation almost every day, especially with other families at Brody's school. The majority have told me that their insurance covers nothing autism related, and one mother has even told me that her husband's insurance (which is through his job and would normally cover the entire family) will not even extend health coverage to her son because of his autism being a "pre-existing condition." When she asked them what exactly she was supposed to do if her son became ill or needed to see a doctor, the insurance representative on the other end of the phone suggested that she ask her husband's employer (a very large company) to change insurance providers. How helpful.
I'll admit that it's very hard not to become bitter once you see your claims for important therapies or tests just being refuted by your insurance company over and over again. This becomes even harder while watching friends and family members get insurance assistance for smoking cessation aids, diet pills, and things of that nature. I've sat and wondered many times what entitles someone to insurance assistance to quit smoking, stop doing drugs, or lose weight while my child (and millions of others) apparently does not deserve to learn how to walk or speak. While it's human nature to feel that way, I've finally come to the conclusion that the best thing I and others can do is to keep fighting.
Write letters, get in contact with your local officials, and let your insurance company know how you feel. That's what I'm in the process of doing right now, and I have my fingers crossed that maybe this year will be the year.
Does your state offer insurance coverage for children with autism?
Previous Special Needs Living posts from aurorabunny:
5 Tips for Special Needs Gift-Buying: Special Needs Living
Balancing Playtime & Therapy Time: Special Needs Living
The Holidays & Autism: Special Needs Living
Mastectomy Photos Banned in Another Facebook Fail
Arrest in Etan Patz Missing Child Case (VIDEO)
A Chilling Past Life Experience Recounted
3 Red White & Blue Cocktails
Controversy: Gwen Stefani Bleaches Her Son's Hair
A '50 Shades of Grey' Shortcut for Busy Moms
Latest on Baby in Washing Machine Case (VIDEO)
Are People Who Eat Organic Judgy & Mean?
A Dad's Perspective on Playdates
Bagged Salad Recall Sparks New Fears
Help Dying 4-Year-Old Fulfill His Bucket List (VIDEO)
Melissa McCarthy & Sandra Bullock's Buddy Cop Movie
Do Working Moms Have It Easy?
Your Morning Coffee Could Save Your Life
Join the Fight Against Toxic Kids' Products
Ashley Is a Widow Who Stays Strong...
Stephanie is a Surrogate Mom
I Named My Kid SpongeBob!
Emma Lives with Severe Food Allergies

Comments (7)
Wow, I honestly had never even THOUGHT about the fact that an insurance company would look at a child with autism any differently. The fact that they will shove these kids aside for whatever reason is very upsetting but not surprising. :( I really really hope and pray that some changes will be made in your state regarding the coverage you will get. I am curious now to know what coverage is like in my state....
KT, me too! I can't believe they call Autism a pre-existing condition! That's so sad! I have no idea what our state covers, but I know Idaho's WAY behind in beneficial safety/healthcare laws.
While our kids have different needs, we seem to be dealing with similar insurance issues. I'm still amazed at some of the reasons for denials and exclusions. I'm so glad you bring these things to light.
Kaite, I don't really understand their rationale for denying coverage for autism. They are required by federal law now to treat mental illnesses the same as "other" illnesses now; and since autism has a DSM IV code, then you could argue that it is a mental illness. Why is it that they deny it?
Autism is not classified under mental illness with insurance companies, it's under "developmental disabilities". While I don't think it is a mental illness, I almost wish they would classify it as such because it would make things easier.
I agree with you Katie. I see claims denied day in and day out because the "pount zero" is missing from the DX codes. Really? Splitting hairs is what is happening, and if the insurance companies could just stream-line some of their language, life would be so much simpler all the way around.
And "pre-existing condition"? Because the child with autism was the same in utero before they were active with the insurance? Aren't children born every day with physical disabilities? Pretty sure those aren't getting denied. Ugh. I learn from you every day, Katie. Thank you.
Well my questions is...who cares if it is a preexisting condition or not...MOST of the time one can not help a condition they have...so why penalize them for it. Oh you were born with _____ darn...you aren't eligible for insurance...whatever.