As parents of children with autistic spectrum disorders, many of you know that we have to fight our educational systems to get quality educational programs for our kids. Unfortunately, we often have to fight the health care system for medically necessary treatments for our kids as well. Companies and health plans often don't want to pay for these services, especially early intensive interventions, which can be costly. Frequently we have to make our case. It is a process that takes time and determination. The Autism Health Insurance Project is here to walk you through that process. Once you win, the insurer will provide the benefits for a long enough time that it can make a meaningful difference in the life of your child.

WHY HEALTH INSURANCE?

Why should my private health insurance pay for my child's autism treatments? Autism is a medical /neurological condition which impacts the way the brain functions. It requires early and intensive medical and educational interventions in order to have the best possible outcomes for our children. The Department of Developmental Services (in CA, administered through the Regional Centers system) also offer some services for some children with autism who meet their criteria, but frequently children on the autism spectrum with moderate impairments do not qualify for their services. Recent changes in the CA regional center system now require families to first apply for treatments through their health insurance system and obtain denials before they will provide medically necessary treatments, as the regional center is the payer of last resort. Both regional centers and school districts, which also provide services to children ages 3 - 22 who meet special education eligibility criteria, are part of the public sector, are funded through tax dollars, and have recently suffered extreme budget cuts. The private health insurance industry, in contrast, is a multi-billion dollar for-profit industry that we pay into every month.

WHO REGULATES YOUR HEALTH INSURANCE?

One of the first questions we ask families is "What type of health insurance do you have?"

Most private health insurance is usually either state regulated or self insured.

If you don't know what type of plan you have, the fastest way to find out is to ask your benefits administrator at work. Generally, most companies with over 1,000 employees are self-funded; most companies with less than 100 employees and most individual plans are state regulated. Some companies offer both types. You can look in your Evidence of Coverage or Plan Description manuals. If you've had a claim denied, your insurance company is supposed to describe how to handle a grievance and what agency you contact if you don't agree with the results of an appeal.