Depending on what type of health insurance plan you have (HMO, PPO, POS, etc.), your health insurance may fully or partially cover some or all of the evaluations, therapies, treatments and interventions your child with autism needs. A little investigation on your part will uncover whether and how helpful your health insurance plan will be as a funding source for autism treatment.
Analyze Your Health Insurance Policy
The first thing you need to do is conduct a bit of (health insurance) policy analysis. Read your health insurance handbook and statement of coverage, as well as any other document you can get your hands on that spells out exactly which services related to your child’s autism treatment your insurance will cover. Write down any questions you have and contact your health plan’s member services hotline to address your concerns.
Find out specifically what coverage and benefit limitations your plan has; how much your out-of-pocket costs (such as co-payments and deductibles) will be; whether your health insurance plan offers specific benefits for autism, the maximum number of therapy visits (speech, OT, PT) your plan allows on both annual and lifetime basis; whether your plan limits coverage for specific diagnosis codes; and which, if any, mental health service your health insurance plan covers.
Be sure to ask what procedures you need to follow in order to file a successful claim for covered services. Find out whether you need a referral, a prescription, a letter of medical necessity, support letters from therapists, school personnel, etc.
Inquire about procedures for filing an appeal if your claim is denied. Obtain the address, fax and phone numbers for your health insurance provider’s appeals department.
Keep Thorough Records
Once you’ve found out what is covered and what you need to do in order to file a successful claim, start a documentation file for keeping copies of all paperwork related to your child’s autism treatment. Keep copies of receipts, prescriptions, invoices, explanation of benefits (EOB) forms, letters of medical necessity and support letters from physicians, therapists, teachers, case managers and social workers.
Good recordkeeping practices will help you immensely in terms of managing your claims, appealing claim denials and preparing to file your income taxes.
Determination and Persistence Will Pay Off
Despite the well-publicized difficulties and frustrations some families have encountered while attempting to fund autism treatment through health insurance policies, it is very much worth your effort to find out which autism treatments your insurance will cover and to proactively seek payment of any eligible covered expenses by your health insurance carrier. Your dogged determination and relentless persistence will help you pay for the autism treatments and interventions your child needs in order to thrive.
For additional information and resources regarding funding autism treatment with health insurance, visit Blessed with Autism and Insurance Help for Autism.
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