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Autism and Insurance - What Should Be Covered?

By August 8, 2008

The costs of autism treatment can be overwhelming. Insurance companies are beginning to cover certain treatments, but their coverage is often very limited.

Part of the reason for the limits is, of course, financial. But there are other issues. For example, some companies pay for autism treatments only up to age 21 (apparently they assume that if the child is still disabled at age 21, treatment is pointless!). Others pay only for treatments recommended by the American Pediatric Association. Still others pay only for treatments NOT provided by schools.

What do you think insurance companies should cover? Vote in the poll (you can select more than one option). And while you're thinking about insurance, what's your take on whether insurance companies should cover ancillary services such as respite care, 1:1 aides in community settings, and specialized equipment such as weighted vests, sensory toys, etc?

Your comments are welcome!

August 9, 2008 at 11:24 am
(1) Sandy says:

Well, the issue of providing services after 21 is interesting. Generally after that age the child has to be dropped off the parents coverage and even disabled, they may then qualify for Medicaid. A whole other topic should be what happens after the child turns 21. My state has a place for developmentally delayed adults, created years ago buy some parents and today it’s a huge Org but many states have nothing.

Some insurances cover in home nurses for medical conditions. I think there has to be a generalized coverage cap for autism related things under insurances. I also do not agree that insurances should have the bulk of all their needs put upon them nor accept every RX a doctor may write. Unlike other disorders, autism has many fly by night offerings. Some of these things, if parents choose to do them, is just always going to be out of pocket. Insurances require documentation on why the services is required, and it must show progress on a regular bases. Now any one can write up a paper stating improvement even if there isn’t any to keep on-going insurance coverage. My question is, when insurances do cover autism related things, where’s the safety net? There’s a zillion interventions out there, and I don’t think insurances should be required to cover them all. One has to consider too, if insurances started covering every single thing, imagine the quacks coming out of the woodwork (and I’ve already seen a few over the years).

My insurance way back when covered O.T. speech and the in-home therapist and any medical tests or procedures required. They would not cover pull-ups, the weighted blanket, respite, PCA or the trampoline. The house insurance wasn’t going to cover that trampoline either. My thought is some of these sensory toys don’t have to be that expensive and instead of buying regular toys (as an example I have a basement full of toys my kid has never played with) spend the money on these other sensory items. I paid 48 bucks for a 12 pound weighted blanket that’s large enough to be folded in half to make more weight, there’s sites that go well beyond that price and sites that charge an enormous amount for sensory toys. I don’t think insurance companies should cover these things, it’s an unregulated area and depending on what therapist you talk to, they have different formula’s for the weighted items and everyone has their own idea of the best sensory toys.

August 9, 2008 at 7:09 pm
(2) Grace says:

I would love to see insurance cover supplements like fish oil & omega-3 capsules whose benefits are fairly well proven & reasonably likely. And I believe that standard speech, physical & occupational therapies should be covered. I know this will upset some, but I don’t support full coverage of ABA when there are way less expensive options like floortime available.

Health insurance is already spiraling out of control & some people don’t seem to realize that the idea that insurance (or the govt) is going to pay for it really means that we’re all going to pay for it. On multiple levels. Watching what prescription insurance has done to pharmacy over the past 25yrs assures me of that. Privitization of health insurance may not be a perfect solution, but at least it would spare us the extreme side of the spectrum of bureaucracy. Then we will probably be able to work out reasonable coverage for the help our kids need without breaking an already nearly broken system.

August 9, 2008 at 8:12 pm
(3) Sandy says:

I think any over the counter obtained item wont ever be covered by insurances. Once Aleve was an RX, now it’s not. Some things may be covered, if they can at all be termed medical supply.

when insurance companies do start adding many things for autism, the premiums will go up and the economy as it is, ours already has increased.

August 14, 2008 at 1:03 pm
(4) Connie says:

My son has a very mild case of Autism and yet if we don’t cover him on group ins. he is not coverage able under private ins. So I think our rising cost of ins kind of stinks anyway because my son is hardly ever sick, but we would be in financial ruin without the coverage because we make to much money for healthwave and it takes them forever to get the application running.

August 14, 2008 at 1:29 pm
(5) sincere says:

I like that you have asked the question. However, I don’t think the selections apply to what I think insurance should cover. My son has autism and there are medically necessary treatments recommended by his physician. I believe in order for these to be covered they should also be effective and measured by medically acceptable measures and have targets to the deficits of the diagnosis and life skills (like eating). Please consider redeveloping these poll selections. I do not believe ANY treatment should be covered at ALL times for ANY diagnsosis – it is shades of gray – but insurance coverage for autism should NOT be a black hole.

August 14, 2008 at 2:29 pm
(6) CamJam says:

In Oregon they have the
Oregon Mental Health Parity law Effective Jan 1 2008, HB 2918 Parity for Pervasive Developmental Disorders:
“(b)Pervasive development disorder” means a neurological condition that includes: Aspergers Syndrome, Autism, developmental delay, developmental disability, or mental retardation.”
(c) “Rehabilitation services” means physical therapy, occupational therapy, or speech therapy services to restore or improve function.

We’ve been VERY frustrated with Kaiser hence this video called No DRUGS for Cameron!

I wrote to several Oregon State Reps that worked hard on getting HB 2918 passed, to find out if our insurance under Kaiser (and not self insured) was above this law… and was told they are not. So now I’m in the process of filing a grievance — not sure it’s going to do any good though. Other insurance companies in Oregon are pulling the same crap. What good is the mandated law when they basically ignore it and are getting away with it? Kaiser is also pulling this crap in California:
Who Pays for Autism Treatment?

We begged to get PT,OT, Speech Therapy for our son but all Kaiser has offered is RITALIN as a solution for our non-aggressive son without giving him any chance with ANY therapy! And our public education system runs on a shoe string budget. If ONLY we made more than a L-5 figure a year…

**sorry for ranting**

August 15, 2008 at 11:47 pm
(7) Robin says:

My son has High Functioning Autism, and i think any and all treatments for Autism should be covered. there should not be any exceptions! Parents of children or Adults with Autism should not have this added stress..We have enough to deal with!!

June 1, 2009 at 12:41 am
(8) Donna says:

I would like to see weighted blankets covered. We purchased ours from weightedblanket.net and my daughter no longer takes sleep meds. Insurance pays for the meds, why not the blanket which is much cheaper in the long run.

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