Tuesday, August 9, 2011

Your company and your insurance

This is a post all about insurance and what you need to know about autism coverage.  I have a friend, Tiffany, who has an autistic son.  She is fighting with her insurance and her company to get her sons ABA therapy covered.  She gave me a lot of information that may help you out there.  You may want to look up if your state has laws stating that autism and treatment must be covered.  You can find this at http://www.ncsl.gov/ and then in the search engine type “autism and insurance coverage state laws”.  Then scroll down to your state.  Once you see if your state has a law, then you want to check if your company is self funded or fully funded and you can look up the differences at http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.feathouston.org%2Fresources%2Fhow-do-i-access-aba%2Finsurance&h=xAQBa3CZf  Basically what she told me was “Self funded means the company has a pool of money that the claims are paid from. There is what is called a stop loss coverage that protects these companies from a very large medical claim. You can call the company and see if they opted for a stop loss plan. Then ask have you met that stop loss. It is worth a try. Once you are over the stop loss then the company can file the claim to that stop loss carrier which is mandated by the state law to cover autism therapy.”  Also, self funded insurances do not have to abide by the state laws only the labor laws.  Fully funded insurances do have to abide by the law.  In addition individual plans, at least in the state of Texas, do not have to cover autistic children.  Also, my friend told me that if you want to appeal to your company to cover autism you can contact autism speaks.  They have a presentation that basically shows that early treatment now will save the company tons of money in medical (not behavioral) expenses later on.  The good thing about a self funded company is that the company has the choice to add coverage to their plan.  Obviously no company wants to because it is more expensive, but sometimes I have heard that a letter to HR could work.  We (my husband and I) have decided not to appeal to his company.  We asked and they did not cover it and we believe it is because it was too expensive.  We feel very blessed and very fortunate to have a great job that my husband is good at and loves.  He loves his coworkers and I believe that if its possible in the future they may cover behavioral health, but until then we are on our own.  The crazy thing is that autism is effecting 1 in 110 (every site has different numbers) kids and this is still an issue.  I hurt for Tiffany who is fighting this.  Tiffany's son also has hemophelia.  That condition has the highest cost of any other childhood illness.  All she wants is therapy for her son.  She told me after she fights for ABA therapy to be covered she is then appealing for speech therapy.  Can you even imagine having an autistic child with hemophelia and the stresses of an appeal?  Please pray for her and all of us with no coverage.  Pray for the children mostly, because they are the ones suffering.  It is outrageous that we not only have to deal with a child with autism, but to also have to fight the insurance companies, and all the money problems, ect.... So good luck out there to all of you fighting this battle.  I know it is so stressful and painful, but I encourage you to turn to the Lord in times like this.  That is the only reason why I am still smiling.  Remember you are not alone.  There are many seminars you can attend to learn some basics of therapy yourself.  While I know that isn't as good as the "real thing" its a start.  Thats where we are starting.  We have been offered help from some amazing, smart women who are giving advise and even using their skills to try and help Jacob.  I am reading books on different therapies to get educated on how to handle him.  There are also ABA consultants that can come to your home to teach you how to start a program at home.  Its still expensive, but much cheaper than sending them to a clinic for therapy.  I am trying to contact a few people regarding that as well.  Lastly, you always have the option of trying to find a job that has group coverage.  Make sure it is a company that has fully funded group insurance and try to get covered.  In 2010 national law was passed that no child may be turned down due to pre existing conditions so your child should get coverage.  With all that said I ask, plead for you to pray for all the families with no insurance and also to say a special prayer for Tiffany and her son Wesley. 

For it is you who light my lamp; the LORD my God lightens my darkness.  For by you I can run against a troop, and by my God I can leap over a wall.  This God-his way is perfect; the word of the LORD proves true; he is a shield for all those who take refuge in him. Psalm 18:28-30

1 comment:

  1. Great news! I read Dr. Goldberg's interview, and want to read more...by him & by other authors. I would like to start with some of the ones you are reading so we can "be on the same page". I already am adjusting some long-standing, deep-rooted attitudes and beliefs from what I've already read. I want to read more! Post or privately email me a list of authors to check out, please?!
    I love you,