Health Insurance For the Treatment of Autism Post 2014

autismFor families that are faced with Autism, there is great concern about how the new health care laws will impact them.

All of the insurance companies that will be participating have filed their plans with the Indianapolis Department of Insurance. From what we can tell, it looks like all of the plans will cover the Autism Mandate. It doesn’t matter if the plan is on the exchange or off of the exchange, the mandate will be covered.

When we look a the Federal Exchange plans, these plans are all HMO plans (Health Maintenance Organization) and operating on narrow networks. These plans state they are covering Autism under the mandate. The question is this: how difficult will it be to go out of network for the treatment of Autism? Unfortunately, we cannot answer this until we have actual claims. On an HMO plan, your doctor is the gate keeper to all of your care, so every medical procedure would have to be approved by your attending physician. This would add one more layer to the process of getting a treatment covered.

Outside of the exchange, we should see the same level of coverage that we have today. If you purchase a policy on a PPO plan (Preferred Provider Organization), then you will have one less obstacle to getting care covered. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician. One issue that we are waiting on is if stand-alone child policies will be available, which would help families a great deal if they only have to pay premium on the child.

From a carrier standpoint, our options are going to be limited.  We predict there will only be a handful of carriers selling PPO plans off the exchange. Right now, it looks like Humana and Anthem will be the main carriers.  UnitedHealthOne and Medical Mutual will not be offering individual health plans next year. Autism treatment facilities will want to build relationships with Humana and Anthem as they may be the only carriers left in the PPO market.

If the exchange plans work out, we could end up adding three more carriers to the equation, which would give us a total of five carrier options. The question then becomes this: do you want to be the first person to file claims for the treatment of Autism with a carrier that does not have experience in that field?

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