My DH just started a new job and he's trying to pick an insurance plan. All the plans that his job offers are from the same insurance company. He called them so he could compare the plans and figure out which plan has the right benefits for our boys (both on the spectrum). He was very surprised to be told that none of the plans cover autism. Does anyone know if this is even legal?
I'm assuming by "not covering Autism", you're referring to ABA Therapy. I would be very surprised if his company plan didn't cover OT, PT, Speech (traditional therapies), as these are not specific to Autism, and are usually covered by all plans. Even if your state has a mandate for Autism Insurance Coverage, the rules/stipulations of that law vary by state, so check out the law in your state. However, my guess would be that your state may have a mandate, but this is not typically applicable to employer coverage. In other words, it is their choice whether or not they want to cover it and they typically don't because it is too expensive. I wrote to my company (using help packet from Autism Speaks), and convinced them to cover ABA....this is a rare outcome. You can always research plans in the individual marketplace/healthcare.gov to see what they do and don't cover in your state in terms of ABA therapy. ABA is not a miracle pill by the way. It helps some kids but not all, and reviews are mixed. There is a ton of help that your child can get from traditional therapies too that ARE cover by insurance. You might look at a site called "rethinkAutism", which provides videos and instruction for parents looking to implement some ABA techniques in their home, or even just get an idea of what it looks like. Good luck hope this helps.
Autism Speaks has a page that might be helpful to you https://www.autismspeaks.org/advocacy/insurance
Most insurance companies go out of the their way to avoid covering kids with autism. ABA therapy can be very expensive and last for years so companies won't cover it claiming it's experimental and schools pay to educate kids. Either look into a Medicaid waiver like Katie Beckett or buy insurance on the Affordable Health Care Marketplace. We did both at different times because there is no way we could $40,000 a year for ABA. I don't how it works in DC.
Thanks!