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If you are trying to get Autism benefits for your child, get used to hearing the big N-O.

• No, your insurance doesn’t cover Autism services
• No, you can’t go out of network for Autism benefits
• No, your employer isn’t interested in picking up an Autism rider
• No, your legislators aren’t interested in mandating Autism insurance

The no is intended to discourage you. Often, it is the easiest and safest answer. Often, it is the wrong answer.
At the corporate level, It is typically based on misconceptions such as Autism services are too expensive and consequently, push premiums through the roof. This simply isn’t true. In those states that have enacted an Autism insurance mandate, premiums have gone up less than one percent and in most instances less than half of a percent.  Read about the research in the section Common Sense on our insurance mandate page.

With so many state mandates becoming law, court decisions being rendered, and provisions of the Affordable Care Act coming into play along with other state laws, such as California's own parity act, even the lawyers don't always know or  agree. Insurance companies continue to leave questionable regulations in place until they are challenged, Know that the insurance reps taking your call are often not informed about changes in the law and regulations. Even the literature you read may not be up-to-date.

You will likely get a No. It doesn't matter how well prepared you are, how well informed, and how on target, you will get that No. Please, just consider it part of the process.  It's something we deal with every single day.

You may also find that the best providers, the ones that are recommended by peers and by doctors aren’t in your network.
The reason for this is that some insurance companies are still trying to get away with paying as little as possible, and better providers with high quality staff can’t work for below industry rates. While the ABA field has been around for more than three decades, there are no objective comparisons to be found among providers. While nearly all states require that ABA programs be supervised by a Board Certified Behavior Analyst, the actual provider of services or tutor may not be required to have any training at all. And while some organizations such as Butterfly Effects, require a complete background check, ABA training, college credit in a relevant field, and ongoing supervision, other agencies look to hire the best they can hire for the least amount of money.

However, if your insurance allows you  to go out of network for physical-medical needs, insurance companies legally have to allow you to go out of network for behavioral services. Behavior therapy is not something to be engaged on the cheap. You will always be able to find providers who can provide a warm body, but if you go with the cheapest available, you will end up getting just what you paid for.

A Few Insurance Terms you Need to Know

Fully-Insured – Refers to insurance policies totally underwritten by insurance companies. In most cases, these insurers are subject to the state insurance laws for the state in which the policy is written. State Autism mandates apply only to fully-insured policies

Self-Funded – Refers to those large companies that cover all insurance benefits on their own. Usually, these are administered by a national insurance company such as United Health. These policies are not subject to state laws but are regulated by the Federal government.

Autism Insurance Mandate – Now passed in 31 states... law stating that insurance companies must provide ABA services for children diagnosed with Autism. Mandate vary state to state. Check the status of your state.

ABA Rider –Optional Autism insurance that some employers opt to add to employee insurance. 

Habilitative Services – ABA services are often included as part of habilitative services, services which are used to teach new skills rather than rehabilitation. It used to be common for insurers to ban ABA as a habilitative service. With new legislation and regulations coming into play, this distinctive is not as prominent as it was a few years ago.

The Federal Mental Health Parity Act –This part of the Affordable Care Act enacted in 2010, states that if an insurer provides mental health / behavioral services, they must be delivered under the same terms as for physical conditions. This means the insurers must permit out of network purchases and adhere to caps set on medical services rather than arbitrarily limit spending and number of visits.

If you believe that your child needs Autism Services and you have insurance:

Check with Your HR Department and/or Insurer to See if You Are Covered
Ask for a written copy of your up-to-date policy if you don’t have one.  Remember, if you are in a state with a mandate, Autism insurance needs to be an option. In some case,s Autism insurance might be optional requiring you to sign on during open enrollment. If you have an individual policy, you can adopt that optional rider at any time. If you are insured by your employer you will need to wait for the next open enrollment period.

Give Butterfly Effects a Call
We can help you with the paperwork and even act on your behalf with the insurance company. If you need to go out of network, we can talk to you about what costs you will incur.

Submit your Paperwork
Get exactly what is requested into your insurer in as timely a fashion as possible. And then, stay the course! You may have to resubmit paperwork, be requested to provide different codes, or simply be put on hold. These are all efforts to get you to give up. They are simply hurdles to be overcome, not impassable barricades.
 

If you don’t have Autism insurance, you can:

Move to Another State
In those states where the legislators are refusing to budge, families are giving up and moving to states where their children with Autism can receive treatment. That’s a judgment call that only you and your family can make. Visit our website for a list of those states actively considering an insurance mandate

Go to Work for a Self-Insured Company
A number of larger companies fund their own insurance and several of these have adopted an Autism rider. In some families, the secondary earner has taken a job with a national chain to get the Autism benefit that more than makes up for any salary degradation.
Go to our list of self-insured companies with an Autism rider.

Join the Military
TRICARE insurance provided by the armed services offers the families of service personnel excellent Autism benefits. The Pentagon recognizes that many choose to reenlist to keep that benefit. A recent federal court ruling has now made this benefit available to nonactive personnel or veterans... with some limitations.