When it comes to navigating through the world of health insurance for your child who may have autism (or any other developmental disorder), it can be tricky…and murky. I know firsthand how difficult it can be to understand what kinds of issues are actually covered under Hawaii’s health insurance policies, and which ones are up to you to pay.
I did some googling, and found this article helpful as a starting off point. It lists specific facts about the Affordable Care Act that would be useful for any family struggling with autism and understanding what insurance should cover.
1. The good news is that most health insurance plans are no longer allowed to deny, limit or charge more for coverage to anyone based on a pre-existing conditions. This includes autism, and other related conditions.
2. When it comes to autism screening, for children at 18 and 24 months, all Marketplace health plans and also most other private insurance plans must cover preventive services without charging a copayment or coinsurance.
3. There’s no such thing as a lifetime dollar limit anymore. Before, many plans had set a dollar limit on covered benefits during the time individuals were enrolled in the plan, which meant children and families who have autism had to pay for all care that exceeded a specific limit.
4. Adults can be covered under parents’ insurance for up to the age of 26. With all the restrictions and obstacles that autism can place upon a young individual, this allows for more flexibility and options.
If you believe that your child's rights have been violated with regard to health insurance coverage, call your state's Insurance Commissioner and speak with an investigator. I've done it several times due to denial of coverage and inconsistencies in policy, which ultimately helped overturn an unfavorable decision. Insurance companies bank on the fact that most people won't question or fight their decision! If you are not satisfied with their determination, there are things you CAN do.
If you’re interested in learning more, here are a couple more resources that were useful.