Here at Nefouse & Associates we have been insuring children that suffer from Autism for almost 5 years. I feel we are the most experienced Brokers in the state when it comes to insuring autism.
The past few years children suffering from Autism have been very fortunate with the Indianapolis Autism mandate. Under the mandate Autism has to be covered as any other illness with few limitations on treatment.
Anthem has been the leader in the health insurance industry for treating Autism. They have set up their own claim division that has processed claims. The majority of these claims have come from out of network providers. Anthem has treated these claims as if they were in network providers because they have not established a network for Autism. The Autism providers have been able to treat patients and be paid without joining any kind of network. This is about to change!
Currently Anthem is building a Autism network. This is going to change the way people are treated for Autism. In the near future Doctors, Facilities, and Specialists will have to be a part of the Anthem network or the claims will go toward out of network deductibles for policy holders. This could create a disruption in treatment and payment for both patients and providers.
On the provider side of it if they do not join network they might have problems getting paid by the carriers. If its a out of network claim then the insurance company could send the payment directly to the insured.
On the patient side if the claim is considered out of network then carrier could usual and customary charge for the claim. This means the provider charges $500 for a procedure but the insurance company states the average price for this is $200. The insured its stuck with the difference.
Anthem is building this new network and its not expected to go live until April. If Anthem is building one then the other national carriers are not far behind.
If you have a loved one suffering from Autism then start asking questions of your provider about them joining a network.