How to Get Health Insurance for an Autistic Child

Obtaining coverage for autism spectrum disorders for children has historically been difficult. Because current treatments and therapies cover symptoms, and not the underlying disorder, the health insurance industry frequently categorizes autism as a psychological disorder rather than a medical event. Health insurance policies are structured to cover the risk of an unknown, unforeseeable major medical event, and not a known chronic condition such as autism.

Instructions

• 1

  Obtain group "guaranteed issue" coverage. Guaranteed issue means that you or your family cannot be turned down for medical reasons; the insurance company is required to provide coverage for all members of the group. The most common way to obtain group coverage is through your employer, though some trade or avocation associations also make group health insurance coverage available to members. Some employers specifically provide insurance that covers autism spectrum disorders, according to Jeff Sell, vice president of public policy for the Autism Society of America. As of late 2010, those companies included Microsoft, AMC and Home Depot.

• 2

  Move to another state. As of 2010, 11 states have passed legislation mandating that health insurers cover autism treatment: Colorado, Delaware, Georgia, Iowa, Indiana, Kentucky, Maryland, Missouri, New Jersey, New York, South Carolina and Tennessee, according to the Council for Affordable Health Insurance.

• 3

  Have your doctor write a letter to the insurance company explaining that ongoing therapy and treatment is a medically necessary protocol for your autistic child. If your state has a mandate, ask your doctor to specifically refer to the state law mandating coverage for autism treatment in the letter.

• 4

  Appeal any denials of coverage, using the process outlined in your policy or coverage manual. Be sure to keep careful records of all correspondence and conversations both with your doctors and with the insurance company. Your doctor can help you document the medical necessity of any planned courses of treatment in writing. Appeals are frequently reviewed by staff physicians at the insurance company.

• 5

  Contact your state insurance commissioner if you believe you have been wrongly denied coverage. You can find your state insurance regulation office contact information via the National Association of Insurance Commissioners (see Resources).