Insurance Coverage for Autism Treatment Begins October 1, 2011
By Claudia Pringles, Developmental Disabilities Specialist
As early as October 1st, private insurance companies will no longer be able to specifically exclude or severely limit coverage of necessary treatments for children with autism. This is wonderful news for families who struggle to pay out of pocket or go without necessary treatments for their young children on the spectrum.
Families with health insurance through companies like Cigna, Blue Cross and Blue Shield or MVP can take advantage of this law to seek treatment for their children on the spectrum. The coverage will go into effect starting October 1, 2011 (on such date as a health insurer offers, issues, or renews the health insurance plan), but no later than July 1, 2012. Insurance companies are not permitted to increase their rates or require additional co-pays to cover autism treatments than they would for any other condition under the plan. Families should contact their insurance company for more information and to enroll their child if not already on their health plan.
Act 127 also provides for expanded state Medicaid coverage of autism related treatments starting in July of 2012. Parents of children who have access to both private insurance and Medicaid may wish to do their research to see which coverage best meets their child’s needs. Medicaid and private insurance pay different reimbursement rates for providers, which in turn may have a significant impact on who accepts Medicaid and who only accepts private insurance.
Under the new law, physicians and licensed psychologists can prescribe “medically necessary” treatments for autism including behavior therapy, speech therapy, occupational therapy and more. Parents who have concerns about their ASD children should discuss their concerns with one of these professionals
Vermont’s Act 127 applies to children on the autism spectrum ages 18 months to 6 years or the beginning of first grade, whichever occurs first.
Act 127 can be located here
Developmental Disabilities Information, Referral and Assistance is sponsored by a grant from the Vermont Developmental Disabilities Council. Contact VFN at 1-800-800-4005 for any questions regarding developmental disabilities.
Vermont’s law applies to children on the autism spectrum ages 18 months to 6 years or the beginning of first grade, whichever occurs first. Developmental Disability, Information, Referral and Assistance is sponsored by a grant from the Vermont Developmental Disabilities Council and the Vermont Family Network.
