insurance for autism in TX

greyt00

Has anyone shopped the new ACA plans in TX?  It's an autism mandate state, which sounds AWESOME, but I'm not totally educated yet.  We need to get on a plan for Jan 1.  Feeling a bit overwhelmed.  I applied at healthcare.gov but didn't put an adult on it and didn't like my options so now customer service has to go and modify my app or something, 2-5 business days (in theory, maybe it will take forever).  Was looking at Humana Connect Platinum 0/1500 Plan.  It's HMO, so we will probably have to get all new doctors.  Ugh.  I've always been spoiled with PPO and could go anywhere.  I really don't have time to start over with new doctors, but getting tens of thousands of dollars of therapy coverage is priority one.  Anyone else going through this?

mommy0411

I live in Texas and someone in a support group I am in said today that ABA is covered in the health exchange plans. Speech, OT and PT should also be covered according to the mandate. The level of coverage will of course depend on the plan. You may want to call Humana to see how they handle autism. I have united and they have been incredibly difficult to work with. Right now they are telling me the mandate doesn't apply to my son until age 3 which is no where in the law. We are currently dealing with their legal department as a result. Good luck!

greyt00

I did an online chat with someone at Humana who could find nothing about autism or developmental delay being excluded.  Sounds like OT and speech are covered.  ABA simply wasn't mentioned.  That doesn't give me the warm fuzzies, so I'm going to call on Monday to speak with someone.  We had heard that several people using the treatment program we are about to use (and another one that we looked at) use United Healthcare's "Golden Rule" policy.  DH applied to that one (an old plan not under the new laws) with the kids and he was rejected.  Now I'm applying but I guess I expect them to reject me, too.  I think the premiums for the new Humana plan aren't much higher, so maybe we're better off with a new one.  

I'm sorry you got stuck dealing with the legal department.  I hope you win soon. 

mommy0411

What is United's "Golden Rule" policy if you don't mind telling me @greyt00 and that sounds like a good plan!

greyt00

It's just one of their flavors of insurance plans.  You can call 1-877-247-0209 to get a rep.  We got a tip from one of the ABA places around here.  Some people have acquired that insurance solely for the autism coverage.  We tried to do that but they rejected DH because of sleep apnea (you need an adult on the plan).  We'll see if they reject me.  Oh noes, I have a thyroid condition.  :-P  It supposedly covers occupational therapy, speech therapy, and ABA, with no limits.  We were going after a $2500 deductible with 100% coverage after that.  No co-pays so we'd pay 100% on everything until we reach deductible. 

https://www.goldenrule.com/

I see something on the online form that says children alone policy, but that doesn't work on the old plan we were trying to get.  They don't offer the new ACA plans (the ones the mandates apply to, all the new regulations) in TX.

greyt00

We got accepted to Golden Rule but most of my issues (acne, arthritis, and allergies) have been excluded.  Another sacrifice.  Our premium was marked up (from the estimate  based on # of people, gender, and age) 60% for DS2 and 160% for DS1 based on the information I gave them.