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The Indiana Insurance Mandate for Autism has been a big discussion on another listserv that I belong to. Many Anthem members are upset about the recently imposed limits placed on therapy visits.
For example, if therapy visits for a medical issue (as in physical injury/illness) are limited to 25 visits, then it is allowable for the insurance company to limit visits for a child with an ASD to the same amount. We received our limits on Sam late last year. We are allowed 25 visits.
There is currently no limit on therapies dealing with behaviors (presumably because there is no medical/physical alternative?). You can read the clipped e-mail below for more info.
Also, Brad and I received a nice letter back from one of our state senators in regards to the Valentine's cards we sent out. I realize how these things work, as I've sent things in the past, but I thought it was impressive that a response was sent out so quickly! Just this insurance issue alone was re-interpreted by the current administration...proving how important it is that we speak up and make our struggles known to our elected officials.
Brooke
Autism Insurance Mandate - response from IRCA
Posted by: "emery@..." emery@... tory_1026
Wed Feb 20, 2008 10:08 am (PST)
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Here is the response I got from IRCA regarding the autism mandate
and limits on yearly visits:
"The law did not change, the way the IDOI interpreted the
law changed in 2003 when the personnel (Commissioner and Deputy
Commissioners for Health Care) changed with the new
administration.
Per Bulletin 136, which had been widely distributed by the autism
community
leaders, insurers may place visit limitations on OT, Speech and
PT as long
as the same limits are imposed upon physical illnesses. This was
not the
intent when the law was written, and it was not enforced this way
prior to
Bulletin 136, but that is the current interpretation. Anthem, I
guess, is
just catching up to that.
If the insurer allows for extensions beyond the visit limits for
physical
illnesses based upon medical necessity, they must also do so for
autism. I
strongly encourage any family that is under limitations to
document ANY
regression and apply for an extension of benefits beyond the
limits of the
plan based upon medical necessity."
SO, if you can document regression, I would assume through
standard testing, then you can go back to your insurance company
and ask for more visits. I don't know how difficult it will be
but I am sure going to try!
Geneva,Arial,
#ffffff;color: black;}
Here is the response I got from IRCA regarding the autism mandate
and limits on yearly visits:
"The law did not change, the way the IDOI interpreted the
law changed in 2003 when the personnel (Commissioner and Deputy
Commissioners for Health Care) changed with the new
administration.
Per Bulletin 136, which had been widely distributed by the autism
community
leaders, insurers may place visit limitations on OT, Speech and
PT as long
as the same limits are imposed upon physical illnesses. This was
not the
intent when the law was written, and it was not enforced this way
prior to
Bulletin 136, but that is the current interpretation. Anthem, I
guess, is
just catching up to that.
If the insurer allows for extensions beyond the visit limits for
physical
illnesses based upon medical necessity, they must also do so for
autism. I
strongly encourage any family that is under limitations to
document ANY
regression and apply for an extension of benefits beyond the
limits of the
plan based upon medical necessity."
SO, if you can document regression, I would assume through
standard testing, then you can go back to your insurance company
and ask for more visits. I don't know how difficult it will be
but I am sure going to try!
Delicious ideas to please the pickiest eaters. Watch the video on AOL Living.
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