FIRST STEP: Call the number on the insurance card. Immediately ask to be connected to the behavioral health/mental health/substance abuse division of the company (these are the only individuals trained to respond to autism issues).
My doctor told me my child may have autism and that our health insurance may cover services for children with autism. Can you give me information about what is covered for autism or connect me to someone who knows about your autism benefit?
Does my policy cover services for children with autism?
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If “no”; what services do you cover for children with disabilities? Do you cover outpatient speech, OT or PT?
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If “yes”; o What services are covered? Does it pay for ABA (Applied Behavior
Analysis)? Does it pay for speech, occupational or physical therapies for the diagnosis of autism?Are therapies covered as outpatient services? o What ages are covered? o If services are covered, what do we need to do to get those services? Can my primary care physician refer my child for therapy or do we need a diagnosis from an Autism Evaluation Center? If we need to go to a center for an evaluation, what centers are in your network? o If my child does qualify for therapy services, what providers are in your network in my area? o How much would I have to pay? What is my deductible? Are there any co-pays? o What other mental health benefits are covered? Is a neuropsychologist covered?
Please give me your name and direct line.
Please send me a description of my benefits in writing.