Good insurance companies for autism spectrum treatment coverage?

[daisymommy]

If you have an insurance company that has been good to work with and pays well in reguards to treatment for your child on the spectrum, please let me know (either here, or send me a PM) please.

We have Kaiser, and their coverage for therapy stinks to say it nicely.

They are awesome for routine medical care, and I have loved having them with our 4 kids (everything under one roof, 24 hours a day, nearly 7 days a week, and no co-pays until they're 6!).

But now that we have an ASD diagnoses, we may have to switch at the end of this year to an insurance company who will pay for the therapy DS1 so desperately needs. Especially O.T.

Thankfully we have 3 other choices to choose from (I *think* Blue Cross/Blue Shield, United Health Care, and 1-2 others).

Thanks for any recc's.

[JTsMom]

We have BCBS of GA. We've had 2 different plans with them, and both covered 20 sessions of OT/PT, and 20 speech per calendar year.

[elliput]

Up until Nov 1, we have been covered by BCBS of KS. There was no limit to the number of therapy sessions which were covered. I have no idea what is covered with our new insurance.

[egoldber]

You need to read through the details of the plans being offered to you. A BCBS plan offered by one employer can differ significantly from the one offered by another.

[o_mom]

You need to read through the details of the plans being offered to you. A BCBS plan offered by one employer can differ significantly from the one offered by another.

It's not as simple as finding a company that covered well for someone else. State laws also come into play with different states mandating different levels of coverage. Self-insured plans may not even have to follow those mandates anyway.

Hopefully you can figure it out.

[daisymommy]

Thank-you for pointing that out, I wasn't aware there were differences within the same company, depending upon location or employer.

[ett]

Yup, you have to check with your particular plan. When we had United Healthcare they covered something like 30 sessions a year of OT. We currently have Aetna and they cover nothing at all.

Also, our OT knew what codes to use to get it covered.

[daisymommy]

Whats difficult is when we get the packet of prospective plans, it's all so vague, and no details given. I wonder if we can call and find out what they cover in the realm of ASD therapy?

[egoldber]

You need to look at the full plan brochure, not just a plan summary. It should be available on-line.

FWIW, there are typically not benefits or therapies available by diagnosis. There is just coverage for specific types of therapy (mental health, PT, speech, OT) often with limits on number of visits per year, often with a prior authorization required.

Many insurance companies have limits on when they will cover PT, OT and speech. Many will only cover these therapies when there has been a specific illness or injury (like a car accident).

[mytwosons]

You need to look at the full plan brochure, not just a plan summary. It should be available on-line.

FWIW, there are typically not benefits or therapies available by diagnosis. There is just coverage for specific types of therapy (mental health, PT, speech, OT) often with limits on number of visits per year, often with a prior authorization required.

Many insurance companies have limits on when they will cover PT, OT and speech. Many will only cover these therapies when there has been a specific illness or injury (like a car accident).

My son's ST was covered until he was diagnosed. The plan had a provision not to cover developmental disabilities.

Your local ASD support group would know about the local plans.