Most Health Insurance Plans Don’t Cover Autism

Most health insurance plans don’t cover autism. That may be about to change based on a bill being considered in Missouri.

Autism is far more common than we realize, but what many people don’t realize is that most health insurance plans do not provide coverage for this neurological condition. Generally speaking, since each autistic individual is different, autism causes them to have mild to severe problems communicating with others and also struggle with social interactions. In many cases, the most opportune time for intervention is in early childhood and working with a variety of programs that will help them to be able to live a near normal life.

As you might expect, treatment for this disorder runs to the tens of thousands of dollars each year and most parents don’t have access to that kind of money. Sadly, most health insurance plans won’t cover it either. However, there is encouraging news on the horizon, in the form of a bill in the works in Missouri that would require many health insurance carriers to cover autism.

The legislation mandates health insurance plans to cover up to $45,000 annually for applied behavioral analysis therapy (from a licensed provider) for kids under 18. To avoid the possibility of fraud from people posing as therapists, or less than honest therapists wanting to cash in on the insurance wagon, the state is planning on creating a new licensing process. If the bill is signed by the governor, the new rules would roll out on the 1st of January, 2011.

One of the other benefits of this bill is that it includes an annual adjustment of the cap that is tagged to inflation. While it sounds good on first read, those with autistic children do need to know there are some potential catches. Those catches would be that the law would only apply to group health insurance plans regulated by the state; that would mean plans bought through small to mid-sized companies.

For larger corporations, ones who self-insure, this bill would not apply, as they are federally regulated. For any small business that has fewer than 50 workers, an exemption may apply if they prove that the mandate caused their rates to rise over 2.5% the previous year. In a nutshell, there will be various options that include autism coverage for treatment and for diagnosis, but this will not be attached to all of the plans sold in the state.

This is great news that may have many other applications nationwide if the bill proves to be a success and keeps the overall health care budget down, thanks to early intervention allowing those with autism to live a fairly normal life.

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