Homeadults with learning disabilitiesHealth Insurance Coverage For Autism and LD?

Since my husband’s seasonal work didn’t offer health insurance when I left my last out-of-the-home job, I ended up buying an individual plan, and we’ve just kept it since.

Since the US laws have changed a bit, the insurance company has sent us an updated contract for us to peruse. As I was leafing through it, I checked the behavioral mental health section out.

Here’s what I found under the ‘not covered’ section:

  • services for or related to intensive behavioral therapy programs for the treatment of autism spectrum disorders including, but not limited to: Intensive Early Intervention Behavioral Therapy Services (IEIBTS), Intensive Behavioral Intervention (IBI), and Lovaas Therapy
  • services for the treatments of learning disabilities
  • Physical, occupational, and speech therapy services for or related to learning disabilities and disorders, except when medically necessary and provided by an eligible health care provider.
  • Services for or related to therapeutic support of foster care (services designed to enable the foster family to provide a therapeutic family environment or support for the foster child’s improved functioning); treatment of learning disabilities; therapeutic day care and therapeutic camp services; and, hippotherapy (equine movement therapy).

Now, I can understand why the LD treatment isn’t covered for school aged children and people attending college, at least, because most schools are required by law to provide accommodation.

However, it bothers me that newly identified adults wouldn’t be able to get help with therapy, should they need it. There may be assistance programs available on a state-by-state basis, but I wonder how difficult it would be to get involved with them.

What also bothers me the most is how the company doesn’t cover early intervention autism spectrum therapy. I’m sure there are plenty of therapy programs available, but as the bullet note said, those listed aren’t the only ones not covered. There are some available through the government, but what happens if those don’t help?

Again, I know there are programs out there to help families with a member on the spectrum, but I also know that they vary wildly from state to state, and they can be difficult to get into.

Foster care is another unsettling point, but again, I don’t know much about how that works and what resources are available to foster families.

I’m tempted to pull out the old contract we have on file and compare the two. I don’t think those exclusions are new, though.

When I called to get information about getting my learning disabilities reassessed last year, the lady on the other end got rather agitated. She snapped something like “You don’t mean for ADHD and autism do you?” I felt like I had just asked her to cook up her dog and serve it to me or something.

When I said no, she relaxed and was friendly once again. However, it set off bells and whistles.

If I was seeking testing for either one of those, why should it matter? We make our payments, neuropsychology is covered and if anyone under said policy suspected they were on the spectrum or had ADHD, there’s no reason why they should be denied testing.

If a referral is needed, that’s not a big deal, but to react like that to even the possibility was uncalled for.

It was a rather off-putting exchange. Then again, I also hate this health insurance system as a whole, too. With as much as people against all other options may talk about losing freedoms, I wonder if they realize just how restricted they are in what’s covered and what’s not according to available plans in all price brackets.

Anyway, that’s a topic for a different day.

LD and autism are both a bit of a grey area, when it comes to an administrative vantage point. They don’t directly effect physical health, and their presence doesn’t make a person mentally ill, but what other category is there for them?

We don’t have “educational insurance”, unless you count the public school system. Before they were better understood, people who fell into the category were considered mentally ill. Unfortunately, that misconception is still going strong.

I don’t know. The question makes my head hurt to think about, but it’s an important one to countless families in need of help.

The practical thing for anyone concerned with proper LD and autism care should at least check their policies to see what’s covered and what’s not. Unless you already deal with the complications involved with education and health of someone in that end of the neurodiversity neighborhood, it’s probably not something you already know about.

As for me, there are a few more things I’m going to check before deciding what to do. There are a couple of unrelated things in the plan that I’m not thrilled about, too. I have some time before I have to wait until the next open enrollment period, after all.

If anyone would like to share what they find out or know about their insurance coverage in regards to this topic, I’d love to hear it.

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