More questions about therapies

July_2009

Sorry for hijacking the board today. Has anyone successfully got outpatient OT and Speech covered by insurance for an ASD kid? We are getting our speech covered currently, but want to ask if there are other options for OT/ABA therapies. How did you go about it? TIA.

July_2009

-auntie-:

I know people who have had both covered.

A big part depends if you live in a state which mandates insurance coverage for autism therapy, and if you do, whether or not your insurance is underwritten in such a manner to be exempt from such mandates.

Your local support group will have more information on the local 411 for "None of your businessville".

If autism coverage isn't mandated by your state, you are less likely to prevail. Read your policy, it should clearly state what, if any speech and OT therapy are covered and for what dxs. You may have to call to get the actual billing codes.

Some policies are written to excluse developmental delays seeing these as a school district concern. Others will offer a limited number of visits per year or a life cap because they have been written to cover therapy after a trauma, illness or surgery.

Thanks for your input Auntie. Yes, I live in a state where Autism coverage is mandated. I will check my policy coverage statements and make a few phone calls. Hope things work out and I will update if I do get the coverage.  

His(1&only)wife

Our insurance covers both speech and OT for my son who has ASD.  Our state currently does not mandate Autism coverage although that is changing. Our insurance policy is written to cover OT and speech with a Rx from his pediatrician without a specific diagnosis being needed.

July_2009

-auntie-:

https://www.asha.org/Advocacy/state/States-Specific-Autism-Mandates/

 

 

This is what I see for NJ

New Jersey

Requires specified health insurance policies and health benefit plans to provide benefits for treatment of autism or other developmental disability. Coverage shall include: medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan. The maximum benefit amount for a covered person in any calendar year through 2011 shall be $36,000.

Citation: N.J. Rev. Stat. ?17:48-6ii.