Hi SineadCrank,
It sounds like your husband's employer offers a self-funded health plan, where Blue Cross Blue Shield of Illinois is the claims processor. Did you get a copy of the certificate of coverage for the plan? I would look to see if the plan: 1) specifically excludes ABA; or 2) denied your claim because it was not medically necessary. If the plan specifically excludes ABA, then you are out of luck. Self-Funded health plans do not need to follow State Specific mandates that require ABA therapy to be covered. However, if the claim was denied due to ABA not being medically necessary, then you might have a chance at a successful appeal. Not sure about Florida, but in my state their are patient advocacy groups that help appeal denied claims for medical necessity. Please send me a direct message if you would like to discuss further.

In my case, we belong to a health plan that is self insured that specifically excludes ABA. We had to purchase a separate individual policy to cover my son, which covers ABA. In all, it cost us an addition $5,500 (premium plus out of pocket) for the year.

Not sure about Florida, but I only applied for Medicaid for Samuel, not for my wife or myself. He now has both my insurance from work and his Medicaid. We qualified for free Medicaid. I have a friend who makes a little more than I do that pays about $50/mo for his daughter. Fill out the online form, it doesn't take too long, and should tell you instantly what you'll qualify for.

It might be a self funded policy. We did not have the coverage until recently. Hospitals that offer autism programs will cover it. It will probably involve less clinical hours with parent homework. Some offer temporary scholarships. Are you near Il. Masonic or Alexian Brothers? Some therapeutic schools offer ABA, as well as some Autism or special needs public school programs. Our son is in a private school offering ABA, but we do not find it to be as strong as outside. A lot of schools combine programs or do their version of it, which might not be bad. You can also apply for Puns in home support if you have behavioral issues that cause your child to be unsafe. Their are some books that can get you started while trying to appeal such as "The Verbal Behavior Approach."

The other difference is whether the child is labeled disabled. If you apply for SSI and then get it the child is legally disabled and then you can apply for Medicaid and most of the time you will get it. My children are both on SSI and they get Medicaid so they are not on my insurance.

Now SSI is income based so they will take into consideration family income an assets however they is a bottom line benifit you can still get even if you make a lot of money. Your goal would not be to get it for the extra income but for the label.

The thing you would want to find out is if Medicaid in FL covers ABA because it doesn't in all states. I have not been there in four years so I am not sure. The SSI is good to have either way because it is harder to get the older the child is and once they become adults it switched to their income and not the families anymore. As with everything else you you to plan ahead and not wait until the last minute.

My company doesn't cover it either. Luckily, we applied for Medicaid and got it, which has to cover ABA in my state. If not, you'll have to ditch your employer plan and pay a little more for private that will cover it.