If your child is autistic, you are no doubt familiar with the financial and health challenges involved. Unfortunately, many health insurance policies do not cover treatments for what has become a more prevalent condition. Doctor visits, prescriptions, speech and occupational therapy all add to the cost involved: anywhere from $67,000 to $72,000 per year, depending on where the child is on the autism spectrum.
Here are some answers to questions you may have when you are struggling with this family health insurance issue.
Q: Does my state mandate health insurance coverage for autism?
A: The following states currently require all health insurance sold within their borders to offer autism-related coverage, which is a start:
Arizona
Colorado
Connecticut
Florida
Illinois
Indiana
Louisiana
Montana
Nevada
New Jersey
New Mexico
Pennsylvania
South Carolina
Texas
Wisconsin
New Hampshire and Maine also have pending legislation. Remember that the specific types and level of coverage vary among states.
Q: What if my state doesn’t require health insurance plans to cover autism-related treatments?
A: An increasing number of large employers include autism coverage in their plans. Failing that, it is possible to buy family health insurance on the open market–although in some cases, it may be more affordable to buy a specific individual health insurance plan for your child. It is essential to shop around for the right plan, which will provide for the care your child needs.
Q: What should I think about when buying health insurance for my autistic child or children?
A: The needs of the child should come first, just like they should for non-autistic children. You must think about the recommended treatments for your child and the cost of those treatments. Many health insurance options cover autism, but have annual or lifetime limits on the amount that can be spent. Behavioral therapy and other techniques are often expensive, eating through a $36,000 yearly cap surprisingly quickly. A nonverbal child will probably require a more comprehensive policy than a child with a milder form of autism. Some health plans may also limit the number of times per year a child can visit a particular type of therapy session. Also keep in mind that certain medical conditions, such as gastrointentional problems, are more common; therefore, it is important to make sure those are covered.
Q: How can I make sure that my health insurance company doesn’t deny my child’s claim?
A: Health insurance companies have certain protocol and procedures they depend on when deciding whether to approve or deny a medical claim. These procedures are often based on years of scientific studies based on the average population. Individualized treatment is often necessary with autistic children, leaving it to parents to argue in favor of a particular course of action. It is best to pick a plan with a positive reputation and good customer service, and come armed with research and expert referrals.
Q: What if I can’t afford to pay for my child’s autism treatments?
A: There are several options available, including financial subsidies from private organizations like United Healthcare, as well as Medicaid. While the waiting list is long, the program for poor residents will accept children with a sufficiently severe form of autism, regardless of their family’s income. In addition to such waivers, you can bargain with teachers and other caregivers to stretch your healthcare dollars. For example, instead of using your health insurance to duplicate treatment your child is already receiving at school or elsewhere, use it to supplement existing therapy.
(Image Beverly & Pack under CC 2.0)
