5 Tips for Dealing with Health Insurance

Today I wanted to share with you tips for parents who may be struggling through finding insurance coverage for their children. I know firsthand the challenges that we as parents face, especially in Hawai’i where cost of living, let alone health insurance, can rack up for a family of even just three.

Earlier this year, Hawaii passed a bill that mandates therapy coverage for children 14 years and under. Currently, health insurance companies are not required to help cover the costs of autism treatment in Hawaii. But Senate Bill 791, introduced by Sen. Josh Green, would mandate the insurance companies cover up to $25,000 a year in treatment until a child turns 14.

There is a lot to be thankful for with this bill, but it is still a challenging process to see if your child qualifies for insurance. These tips can help you through each step:

1. Understand Your Situation. For children with conditions such as autism, aspraxia, or developmental disorders that require frequent, long term, and intensive therapy, therapy could represent a significant cost for an insurer. Many insurers have clauses excluding therapy coverage for children with developmental disabilities, so familiarize yourself with the codes -  do not use anything that may suggest DD.  Instead ask your pediatrician to use alternate codes.  You want to avoid a denial in the first place.  However, understand before you begin fighting for coverage that you may likely face at least one denial, and perhaps several rounds of appeals. Always remember…don’t give up!  Insurers count on you to throw in the towel.

2. Do Your Homework. The internet and websites for developmental disorders can give you an amazing amount of background information, research articles, citations, textbook, conferences and more. There is also an incredibly rich archive of articles from experts that are perfect for using to support your arguments to the insurance company.


3. Understand Your Plan. It is necessary to thoroughly review your insurance benefits and understand the true scope of benefits. Each company has plans that is specific with services that are limited to a certain amount of time too, so please make sure you understand what your plan includes.


4. Get Local. Look into Hawai’i’s state laws, like the aforementioned Senate Bill 791. A few easy searches on the Hawaii legislature’s websites can yield you all the information that you need. Look into the federal Employee Retirement Income Security Act (ERISA) of 1974. If your employer provides your health insurance through a policy of insurance or a health maintenance organization, ERISA is likely to apply.


5. Gather All Your Documents. Submit everything that can possibly be relevant to your argument to your health insurance company. Gather copies of the full text of website and journal articles, textbook chapters, symposium findings, etc. to back up all your arguments and counter arguments. Address every point the company makes, and provide documentation to counter them.

Stay tuned for tomorrow's blog.  We'll continue our discussion about how to successfully navigate the health insurance maze in Part 2.  See you then!