Is an autism diagnosis retroactive for insurance purposes?

[Anonymous]

We spent $20k out of pocket on speech therapy and many, many years later finally got our autism disagnosis. We didn’t try to get anything, but I understand why you’d try.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

Which is why you should have gotten a diagnosis before starting OT and SLP services, if you wanted reimbursement.

That’s some bad advice. Especially Autism in girls.

I am the OP of this thread and I totally agree. I think insurance should pay but have no regrets about starting services.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

Which is why you should have gotten a diagnosis before starting OT and SLP services, if you wanted reimbursement.

My goodness, I do apologize for wanting to help my child!

I'm not sure if you actually think you're being helpful, but fyi, you are not.

Lashing out at other people won't change the truth of your situation. You can't berate people into building a time machine. Sometimes helping your child costs money.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

Which is why you should have gotten a diagnosis before starting OT and SLP services, if you wanted reimbursement.

That’s some bad advice. Especially Autism in girls.

Avoiding a diagnosis doesn't help girls.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

Which is why you should have gotten a diagnosis before starting OT and SLP services, if you wanted reimbursement.

That’s some bad advice. Especially Autism in girls.

Avoiding a diagnosis doesn't help girls.

I was saying that girls get diagnosed later, at times. And avoiding tberapy for lack of diagnosis is not smart.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

Which is why you should have gotten a diagnosis before starting OT and SLP services, if you wanted reimbursement.

That’s some bad advice. Especially Autism in girls.

Avoiding a diagnosis doesn't help girls.

I was saying that girls get diagnosed later, at times. And avoiding tberapy for lack of diagnosis is not smart.

Well, the PP's advice was don't start if you want reimbursement, not "don't start if your priority is getting your kid the help they need as soon as possible."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

Which is why you should have gotten a diagnosis before starting OT and SLP services, if you wanted reimbursement.

My goodness, I do apologize for wanting to help my child!

I'm not sure if you actually think you're being helpful, but fyi, you are not.

Lashing out at other people won't change the truth of your situation. You can't berate people into building a time machine. Sometimes helping your child costs money.

I'm just being honest. The above did not answer my question and is bad advice in general. Your little lecture about helping my child costing money is completely unwarranted and all about your ego.

[Anonymous]

OP as someone who just had my neoropsych testing rejected by insurance for the third time, I feel your pain. Ignore the snarky comments from previous posters. The insurance process is a test of patience and it feels sometime designed to make you give up.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unlikely. When you got there therapy service, you should have been getting the insurable diagnosis at the same time.

Thanks, but I genuinely have no idea what this means. OTs and SLPs do not diagnose autism.

What dx code did the therapists use when submitting to insurance? Has your insurance told you that the service would be covered if billed under autism?

Since as you say she was always autistic, I would ask the service providers to resubmit using F84.0.

Of course not. That would require them to want to help me get my claims approved.

They didn't tell me I needed prior authorization until I called about why claims were denied. They also didn't tell me the superbills didn't have the right codes on them - a provider noticed that. Now, we have to wait 15 days for the prior authorizations to go through (assuming they admit that they received them, which they haven't yet). Then we will find out if they approved the prior authorizations, and see if they approve the claims with the new codes. I asked about the diagnosis but they did not provide any answer for me.

Each phone call requires spending a minimum of 20 minutes on hold. I am losing patience and we are only getting started.

This is the game they play. Insurance company is trying to wear you down. Even after you get prior authorization, they will reimburse you at 140% of the Medicaid rate, after you’ve exhausted your deductible. In my case it worked out to be about 15-20% of what my private pay therapists billed annually. Sucks and I found it not worth all the administrative work (emotionally taxing). At one point I did an appeal and hired an advocate to cut through the insurance company BS when we were submitting expenses prior to seeking the pre authorization… which worked but it took two years.

My advice: call the behavioral health line for your carrier. Say it’s autism related. Follow directions to a T. Then get reimbursed a low amount. Or just give up. I’m sorry to say.

Signed, been there done that.

[Anonymous]

A person does not have to have autism to have speech and OT covered. Many kids who get speech/ot do not have autism. My insurance pays for a set number of sessions a year.

I would work with the insurer to deal with the billing codes issue and the preauthorizations. Does your providers bill insurance? In my experience, they handle this stuff-but that's just my experience, some may be different.

Hopefully, OP, once this is settled, future claims will go more smoothly for you.

[Anonymous]

Anonymous wrote: A person does not have to have autism to have speech and OT covered. Many kids who get speech/ot do not have autism. My insurance pays for a set number of sessions a year.

I would work with the insurer to deal with the billing codes issue and the preauthorizations. Does your providers bill insurance? In my experience, they handle this stuff-but that's just my experience, some may be different.

Hopefully, OP, once this is settled, future claims will go more smoothly for you.

My providers are out of network. They do not bill insurance. And I understand why - as the PP said, it is their MO to try to wear people down. I'd rather the providers focus on providing care rather than dealing with the sociopaths at my insurance company. It doesn't sound like you work for the insurance company we use because the representatives at mine are not remotely interested in being helpful. I have asked them all of the questions and they put me on hold for 20 minutes and then still don't give me an answer.

[Anonymous]

Op, I don't work for an insurance company. Financially, I had to choose only in network providers. If you're out of network, I guess they don't have to follow the same process.

[Anonymous]

Anonymous wrote:Op, I don't work for an insurance company. Financially, I had to choose only in network providers. If you're out of network, I guess they don't have to follow the same process.

Sorry, I misread your post. I hear you. We are lucky to be able to work with these providers. Our previous insurance didn't cover the services at all so it didn't matter who we used. We switched to this plan specifically for the out of network coverage.

[Anonymous]

My NT kid gets OT services, paid by insurance. Not sure why some of you are whining about how long it takes to get an autism dx. That's irrelevant.

[Anonymous]

Anonymous wrote:My NT kid gets OT services, paid by insurance. Not sure why some of you are whining about how long it takes to get an autism dx. That's irrelevant.

Who is "whining" about this? There is no need to be so rude.

It's absolutely true that an autism diagnosis can help families access services. That doesn't mean insurance won't cover OT for anyone without a diagnosis. My experience is that if a child has something like a fine motor delay they'll cover it without any diagnosis, but for any kind of "sensory integration" work it is harder. And it depends a lot on the plan and the nature of the OT being provided.