I had to buy my own healthcare for a while and I signed up with Medica. I
am not sure if they have it in California but I was quite happy with them.
In the majority of states insurances do not cover anything asd-related
after age 7. We have been having to pay everything out of pocket despite
having healthcare. I don't know how they get away with it. I know that
there are some employers (like Microsoft) who cover autism related
healthcare for ther employee's kids.
I found this on Talk About Curing Autism website. They have a letter there that anyone is free to copy and send to their insurance company. Apparently, there is a California law that makes it mandatory for insurance companies doing business in California to provide coverage for Autism. I know three years ago I had Cigna and they told me they don't cover autism. Anyway, here is part of the letter. The website says anyone can copy and use it.
CALIFORNIA STATE MANDATE LAWS
While you may be trained in the meaning of different terms in your company’s health care plan, please remember that any contractual terms in your plan that attempt to limit coverage for autism are unenforceable in California if they violate California’s state mandates on minimal levels of autism care. Samson v. Transamerica (1981) 30 Cal. 3d 220, 231.178. Cal. Rptr. 323, 350.
Your company had to agree to these state mandates as a condition of doing business in California.
I LIVE IN ORANGE COUNTY CALIFORNIA & HAVE PACIFICARE. THEY HAVE NOT COVERED ANYTHING AS FAR AS SPEECH OR ANY OTHER THEARPY. WE HAVE THE REGIONAL CENTER AS WELL & THEY HAVE NOT PROVIDED US WITH ANY SERVICES. WE WERE JUST APPROVED THIS MONTH FOR RESPITE NOT SURE YET HOW TO USE IT THOUGH IT AVERAGES OUT TO LESS THEN 0 A MONTH. FROM WHAT I UNDERSTAND ITS FOR PAYING A BABYSITTER. GOOD LUCK! I THINK PPO INSURANCES ARE BEST TO HAVE FOR AUTISM BUT THEY ARE SO EXPENSE!!heh, well medical inshurance and all sucks in the US, its so expencive and the common man/women/family has a hard time if someone needs an operation or is real sick, medicin is super expencive and this nation really needs to come up with a way to be on par with the rest of the developed world by having national health inshurance for everybody.hello-
I recently had a huge career change & now i am responsible for funding my families insurance.
blue cross denied my son coverage, as i stated he was diagnosed with autism.
i live in california. i am currently working with the regional center & trying to obtain respit to get medical.
any suggestions for family insurance companies that help autistic children too would greatly be apreciated.
thanks.
thanks for checking.
yeah, i wondered about revealing the pre-existing condition too.....i just didnt want to make things harder down the road..
i am waiting to hear back from a few other insurance companies....i just dont want to spend my money @ an organization that isnt going to support my entire family.
Evan,
With insurance, continuity of coverage is key. If you allow your insurance coverage to lapse for a period of time, and then want to reapply for insurance again in the future, you are starting all over again. Whether you had insurance in the past doesn't matter. Switching insurance companies is very different from letting your coverage lapse and then reapplying.
This is why we have COBRA (passed in 1986). When you leave a company (under certain conditions, things like gross misconduct excluded of course) you have the option of paying out of pocket to continue your company's group health insurance even if you are no longer an active employee. It is not necessarily cheap, but it allows you to maintain that key "continuity of coverage" until you either find another job or arrange for other private insurance. When you have a chronic condition of any kind it is critical to never allow insurance to lapse or you can be completely screwed. In some states, I think CA is one of them, if you go through an employers group health policy you are guaranteed coverage even if you have a preexisting condition. I apologize but I'm not up on the laws in all states, you would have to research further.
There are some companies that will give you insurance with an exclusion for a preexisting condition when going for a private policy. My brother was dx'd with Hep-C during a period of no insurance coverage. My parents purchased a catastrophic health policy (covers major events, hospital stays, surgury but with a very high deductible) but they had to take an exclusion for the HEP-C because it was preexisting (which meant none of my brother's HEP-C meds were coverered.) Later my brother got a job with benefits and he received full coverage, including HEP-C related issues, under his employers plan.
The rules of the game look different when dealing with individual v. group policies. I think it is going to be difficult to get full, affordable coverage with a preexisting condition with a private insurer as an individual. It's a whole different ballgame when you're talking about group coverage through an employer.
Note that this is not limited to health insurance. For example, many insurance companies have pulled out of Florida for homeowners insurance. If you have homeowners today, they can't drop you but they are not writing new policies. If you ever let your homeowners lapse in Florida, you'll likely never get it again and government insurance (insanely high deductibles) is often the only option.
With a special needs child, or any chronic condition, it's better to take a loan to cover premiums, or look into a premium assistance program, than to let coverage lapse for any period of time.
Just wondering, if you were covered with insurance before, how can they deny your son?
I have BC/BS myself, went on it while pregnant with my surroson, a preexisting condition, but was already covered by insurance, just switched and was not denied.
This just does not make sense, I think I'd put up a fight there.
BTW, I did not read the other responses
[QUOTE=1 ShyCladBoy]Just wondering, if you were covered with insurance before, how can they deny your son?[/QUOTE] i was covered through my employeer before. basically once evan was born.
now i am self employeed looking for insurance. i disclosed that evan was dx with autism = denied by blue cross.
[QUOTE=snoopywoman]I am not happy with insurance companies at all. But, I do want to clarify one thing - diabetes is most definitely NOT one in 10,000 people. [/QUOTE]your right, thats what i get for quoting my mom
type 1 is 1 in 400-600 per national institute of diabetes.
[QUOTE=1 ShyCladBoy]Just wondering, if you were covered with insurance before, how can they deny your son?[/QUOTE] i was covered through my employeer before. basically once evan was born.
now i am self employeed looking for insurance. i disclosed that evan was dx with autism = denied by blue cross.
[/QUOTE]
Yes I read that, still you were covered by insurance already, so I have a hard time seeing why they can discriminate in this manner.
^ i didnt realize that would make a difference, since this is a different company.
still waiting on blue shields response.
OH I SEE. WELL I THINK YOUR LETTER TO THE PRES IS A GREAT IDEA BECAUSE SOMETHING HAS TO BE DONE!! IT SEEMS CRAZY THAT EVERYTHING HAS TO BE SUCH A FIGHT FOR OUR KIDS . WE ARE JUST TRYING TO GET THEM THE HELP THATS NEEDED TO BE PRODUCTIVE CITIZENS & TO BE COMFORTABLE IN THERE OWN SKIN. AGAIN GOOD LUCK!I have Aetna PPO. Prior to that I had Cigna PPO. (My company switched from Cigna to Aenta in 2006.)
I am currently getting private speech and OT covered at the 80% out of network rate. I also got my private neuropsych evaluation covered and my neurologist visit.
I submit claims every month. Sometimes they get denied so I just submit them again. Sometimes they want more information (treatment notes, etc.) so we kill a tree and send it in. Sometimes we just keep submitting until we get a processor who just doesn't care and shoves it through without asking questions. So far, so good for us on the insurance front.
BTW, we live in Illinois.
mysunshine- what was explanied to me (have yet to see it happen, as i am in the same boat as you) respite is necessary to have in order to qualify for medical through the regional center......
i think i will try going through another insurance company & with-hold evan's dx.
what gets me, is 100% of these insurance companies they will cover diabetes, which is like 1 in 10k, but autism is averaged @ 1in150....my mother in-law suggested that i should send the president/maybe new president the copy of the blue-cross declining coverage for my son letter , along with how the u.s. views autism & it's epidemic / rampage & ask why in the hell is the u.s.a ignoring this issue like hurricane katrina victims.
I am not happy with insurance companies at all. But, I do want to clarify one thing - diabetes is most definitely NOT one in 10,000 people. It is extremely common and you are much more likely to know someone with diabetes than someone with autism. If you mean type 1 diabetes, that is much less common (this used to be known as juvenile diabetes). Anyway, my dh used to do research in diabetes - so I just had to step in!