Ins Coverage and ASD?

irishbaby0708

Are things covered differently on your insurance once you have ASD dx?  Just curious.

mommyof4boys

NJ has a law that should cover all developmental delays for children.  I don't remember the specifics but do know our insurance agreed to cover because I cited the law a few years back.

finsup

Totally all over the place and depending on state / insurance.

Last year during open enrollment I was comparing what my employer offered vs. what my husbands employer offered.

My employer covered ABA but had a cap at 20 visits per year for OT, PT. 

My husbands employer also covered ABA but unlimited visits for OT and PT if there is an ASD dx.  If no ASD dx then the standard 20 visit limit for OT and PT applied.

d.f

Not with my insurance (through DH's employer),  my state does have a mandate but it excludes self-insurers (which our plan is).  They cover no behavioral therapy unless there is a danger to self or others.  They cover 30 visits of OT and Speech as long as it's recommended by a doctor.   ASD plays no role regarding inclusions or exclusions.

KelleyBean

We are in the process of moving from my insurance to DH's. My state is a mandate state but my company is considered self-insured so they offer no therapy benefits. DH's plan gives $35k a year in ABA with an ASD dx. There is also ST, PT and OT but I'm not sure on limits. I do know it is better than the non-coverage of my employer so it was a no-brainer for us. 

CaptainSerious

On ours, yes, but I don't know all the specifics.