[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
Frequently Asked Questions About the Connecticut Autism Insurance Reform Act:
1. What does the Autism Insurance Reform Act do?
Broadly speaking, the act requires many private insurers to begin covering the costs of diagnostic assessments for autism and services for individuals with autism who are under the age of 15.
Insurance providers can limit the coverage for behavioral therapy in the following manner:
- Benefits up to $50,000 per year for a child under 9;
- Benefits up to $35,000 per year for a child ages 9-12; and
- Benefits up to $25,000 per year for a child ages 13-14.
2. When does the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect?
The law went into effect on January 1, 2010.
3. Once the act goes into effect, will my employer-provided health insurance be required to cover my child’s autism services?
Each group health insurance policy that provides coverage for basic hospital expenses, basic and major medical-surgical expenses, or hospital and medical coverage to subscribers of a health care center will be required to provide coverage for the diagnosis and treatment of autism spectrum disorders.
4. What happens if we get our insurance through an employer that self-insures?
Insurance provided by an employer that self-insures is not subject to the requirements of this act.
5. What happens if we purchase individual health insurance?
As of January 1, 2009, each individual health insurance policy is required to provide coverage for physical therapy, speech therapy, and occupational therapy services for the treatment of autism spectrum disorders to the extent that such services are a covered benefit for other diseases and conditions. Insurance provided by a small employer or an employer that self-insures is not subject to the requirements of this act (i.e., required coverage of behavioral therapy).
6. Are there limits on what our private insurance is going to be required to cover?
Yes. The act lists seven categories of treatments that insurers will be required to cover. There is an annual dollar cap on coverage of behavioral therapies that varies according to age – $50,000 for children under 9; $35,000 for children ages 9-12; and $25,000 for children ages 13-14. There are no limits on the number of visits to a provider. Coverage may be subject to other general limitations and exclusions of the group health insurance policy. However, an insurer cannot place higher copayments, deductibles, or other out-of-pocket expenses on the diagnosis and treatment of an autism spectrum disorder than for the diagnosis and treatment of any other medical, surgical, or physical health condition under the policy.
7. How will the law be enforced?
An insurer that issues a policy that violates this law is subject to a fine of up to $1,000 per offense. The insurance commissioner may also revoke an out-of-state insurer’s license for violating the act’s provision.
Covered Services
1. What coverage is mandated by the law?
The act requires coverage for the following types of services:
- Behavioral therapy, including ABA
- Pharmacy care
- Direct psychiatric or consultative services
- Direct psychological or consultative services
- Physical therapy
- Speech and language pathology, and
- Occupational therapy
Under this law, a policy must cover these services if they are (1) medically necessary, (2) identified and ordered by a licensed physician, psychologist, or clinical social worker for an insured person who has been diagnosed with autism, and (3) based on a treatment plan.
The act also requires coverage for evaluations and tests needed to diagnose your child’s autism disorder.
2. Is applied behavioral analysis (ABA) covered?
Yes, the law’s definition of “behavioral therapy” specifically includes ABA.
3. Will all of the Autism Spectrum diagnoses be covered, or just those diagnoses with the keyword of “autism?”
Any of the pervasive developmental disorders defined in the current edition of the Diagnostic and Statistical Manual (DSM) are covered. These include: Autistic Disorder, Rett’s Disorder, Childhood Disintegration Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.
4. Does Autism Spectrum Disorder (ASD) have to be the primary diagnosis for the child in order to qualify for coverage under the act?
No, there is no requirement that ASD be the “primary” diagnosis for your child to qualify for coverage under that act.
5. Who determines what services are medically necessary?
Your child’s licensed physician, licensed psychologist, or licensed clinical social worker will order the services that he/she identifies as medically necessary in accordance with your child’s treatment plan.
6. Will the new law require insurance companies to cover the cost of social groups? Must it be prescribed by a physician?
The act does not include a “list” of covered services. Rather, the law requires coverage for specific types of services. Therefore, coverage under the bill will be determined by the insurance company based on the requirements of the law, whether the treatment is medically necessary, and whether the treatment is ordered as part of the child’s treatment plan by a licensed physician, licensed psychologist, or licensed clinical social worker.
Private Insurance
1. On January 1, 2010, will an insurance company be able to question my child’s existing autism diagnosis?
No, an autism diagnosis shall be valid for a period of not less than twelve months, unless your child’s licensed physician, licensed psychologist, or licensed clinical social worker determines a shorter period is appropriate or changes the results of your child’s diagnosis.
2. How often will insurance companies be able to review my child’s treatment plan?
Insurance providers may review your child’s treatment plan not once more than once every six months, unless your child’s licensed physician, licensed psychologist, or licensed clinical social worker determines more frequent review is appropriate or changes your child’s treatment plan.
Coinsurance, Copayments, Deductibles, and Other Out-of-Pocket Expenses
1. Can insurance providers charge higher coinsurance, copayments, deductibles, or other out-of-pocket expenses for services for the treatment of ASD?
No, insurance providers may not charge higher coinsurance, copayments, deductibles, or other out-of-pocket expenses for coverage for the diagnosis and treatment of an autism spectrum disorder than for the diagnosis and treatment of any other medical, surgical, or physical health condition under the policy.
Other
1. What is “utilization review”?
“Utilization review” refers to techniques used by health carriers to monitor the use of, or to evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures or settings. Some examples of techniques used include ambulatory review, prospective review, retrospective review, second opinion, certification, concurrent review, case management or retrospective review. (Source: National Association of Insurance Commissioners)
2. What is “grievance review”?
“Grievance review” refers to a health carrier’s internal processes for the resolution of covered persons’ complaints. The complaints may arise out of a utilization review decision or involve the availability, delivery or quality of health care services; claims payment, handling or reimbursement for health care services; or matters pertaining to the contractual relationship between a covered person or health carrier. Some states may call it an “internal appeal” process. (Source: National Association of Insurance Commissioners)
The Autism Community Is Not The Autistic Community
Note/Warning:
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.
International Badass Activists 