CDC autism rates 1 in 68 kids..... 1 in 42 boys!

[Anonymous]

Anonymous wrote:I don't understand the "state mandated coverage" thing. We live in VA and our insurance provider does not cover speech therapy (we need it for low oral motor tone) or OT (again-low motor tone) even though we have an autism diagnosis. What are all these services insurance cos are required to provide?

Citation: Vt. Code Ann. tit. 8 § 4088i
Virginia

Requires health insurance plans issued or renewed after January 1, 2012, to provide coverage for the diagnosis and the treatment of autism spectrum disorder in individuals from age two through age six. An individual who is being treated and continues to need treatment for autism spectrum disorder and becomes seven years of age or older is not precluded from coverage of treatment and services. Treatment shall be determined by a licensed physician or a licensed psychologist to be medically necessary, and includes: (i) behavioral health treatment, (ii) pharmacy care, (iii) psychiatric care, (iv) psychological care, (v) therapeutic care (which includes services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers), and (vi) applied behavior analysis when provided or supervised by a board certified behavior analyst who shall be licensed by the Board of Medicine. Certain insurers may be exempt from requirements for 1 year and may reapply for the exemption yearly.

Citation: Va. Code Ann. § 38.2-3418.17
- See more at: http://www.asha.org/Advocacy/state/States-Specific-Autism-Mandates/#sthash.86zfv9is.ZfoG7Nwl.dpuf

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don't understand the "state mandated coverage" thing. We live in VA and our insurance provider does not cover speech therapy (we need it for low oral motor tone) or OT (again-low motor tone) even though we have an autism diagnosis. What are all these services insurance cos are required to provide?

Citation: Vt. Code Ann. tit. 8 § 4088i
Virginia

Requires health insurance plans issued or renewed after January 1, 2012, to provide coverage for the diagnosis and the treatment of autism spectrum disorder in individuals from age two through age six. An individual who is being treated and continues to need treatment for autism spectrum disorder and becomes seven years of age or older is not precluded from coverage of treatment and services. Treatment shall be determined by a licensed physician or a licensed psychologist to be medically necessary, and includes: (i) behavioral health treatment, (ii) pharmacy care, (iii) psychiatric care, (iv) psychological care, (v) therapeutic care (which includes services provided by licensed or certified speech therapists, occupational therapists, physical therapists, or clinical social workers), and (vi) applied behavior analysis when provided or supervised by a board certified behavior analyst who shall be licensed by the Board of Medicine. Certain insurers may be exempt from requirements for 1 year and may reapply for the exemption yearly.

Citation: Va. Code Ann. § 38.2-3418.17
- See more at: http://www.asha.org/Advocacy/state/States-Specific-Autism-Mandates/#sthash.86zfv9is.ZfoG7Nwl.dpuf

Your insurer may have an exemption. You should check.

[Anonymous]

Anonymous wrote:
Thank you again, PP. Are you the OP of the thread on having your 15 month old evaluated? I've followed that closely. We had our initial evaluation last week, and will be meeting with an evaluator, special educator and SLP on Thursday. I'm really anxious.

Yes, I am. Sorry you are going through this, but it's great he was evaluated this early. Good luck, and let me know if you have any questions.