Law Requires Health Insurers to Cover Autism Services

 In Autism

Health Insurers Required by Law to Cover Autism

Health Insurance Required to Cover Autism

Beginning in 2007, 42 states signed into law, requiring health insurance companies to provide coverage for the treatment of individuals with autism. Unfortunately, some states are still in the process of enacting insurance coverage at this time. However, this law now allows families the opportunity to receive autism services covered by insurance. These services such as these were previously unavailable to them through health insurance, thus making it far more difficult to attain.

Children or adults diagnosed with ASD, including Asperger’s Disorder, Rett Syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorders Not Otherwise Specified (PPD-NOS), who display a medical need for services are now able to receive services covered by health insurance.

However, it is important to note, that evidence-based, medically necessary autism services must be prescribed, provided, or ordered by a licensed physician or licensed psychologist in order to be covered by insured health plans.

Services Now Included:

  • Applied Behavioral Analysis (ABA)
  • Behavioral Health Care
  • Diagnostic Services
  • Pharmacy
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care
  • Assistive Communication Devices

The Effectiveness of ABA Therapy

ABA therapy promotes positive reinforcement, learning in small steps, prompting, and repetition. Additionally, ABA Therapy promotes systematic instruction and strengthens functional skill sets. Also, these services can be provided across a variety of settings. The National Institutes of Health and the Surgeon General of the United States has endorsed ABA as the most effective way to treat ASD. Moreover, according to the National Autism Center’s National Standards Report (2009), data collected through hundreds of studies indicate that ABA is a highly effective method to teach children and adolescents with ASD.

Does your insurance company cover Autism Services?

Currently, Applied ABC has partnered with a myriad of insurance companies. The list includes: Oxford, Empire, Aetna, Fidelis, Ameri-Group, as well as many others. Furthermore, we are always in the process of adding more and more insurance’s to our list that will cover autism services.

Additionally, it is important to note that, insurance companies are constantly in the process of adding coverage for autism therapy. Please, do not hesitate to ask if your insurance company accepts autism therapy for your loved one.

Which insurers are not required by this legislation to cover autism services?

Unfortunately, companies with self-funded insurance plans are not required by this legislation to provide coverage. However, you may ask your company to provide this coverage.

Resource Links

State Initiatives https://www.autismspeaks.org/state-initiatives

New York Initiatives https://www.autismspeaks.org/advocacy/state/new%20york

New Jersey Initiatives https://www.autismspeaks.org/advocacy/state/new%20jersey

Connecticut Initiatives https://www.autismspeaks.org/advocacy/state/connecticut

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