Sunday, January 15, 2012

What Will My Insurance Cover?

There are certain therapies that every Autistic child will be given and most insurance providers will cover these services as well as some extras. If you have Private Insurance then you will need to call them to find out what is covered. I actually find it easier to call the places that offer these services and ask them if they accept your Insurance. If they do then that means your insurance will cover it.

Occupational Therapy: Therapy for those recuperating from illness that encourages rehabilitation by performing the activities of daily life.

Speech-Language Therapy (SLP): Services provided by a qualified speech therapist/pathologist who helps identify and work with children to develop communication skills that could affect the child's ability to make sounds; may include swallowing and breathing techniques.

Physical Therapy: Only in extreme cases will a child on the Spectrum need PT. A branch of rehabilitative health that uses specially designed exercises and equipment to help patients regain or improve their physical abilities.

Behavior Therapy: A form of psychotherapy that uses basic learning techniques to modify maladaptive behavior patterns by substituting new responses.

Applied Behavior Analysis Therapy: (Note my ABA label on the blog to see if your State covers ABA therapy) There are currently only 29 states in the US (you have to reside in one of them) that mandate that your insurance provider pay for ABA therapy.
Behavior analysis is a scientific approach to understanding behavior and how it is affected by the environment. The science of behavior analysis focuses on principles (that is, general laws) about how behavior works, or how learning takes place. For example, one principle of behavior analysis is positive reinforcement. When a behavior is followed by something that is valued (a "reward"), that behavior is likely to be repeated. Through decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may be harmful or that interfere with learning.

The Extras That could be Covered:

1) If your child is over the age of 3 and still not potty trained (due to Autism) you can have your Pediatrician write a prescription for diapers! You do need a ASD medical Diagnosis for this.

2) Your Insurance will pay for an Autism Medical Evaluation and Diagnosis.

3) Instead of buying Childrens Tylenol, ask your Pediatrician to write a Rx. He can also write a Rx for Melatonin, fish oil, vitamins...

4) Handicap Sticker for your Vehicle. Yep, that's right! Go to your local DMV website, print out the application form for the sticker. Take it to your doctor, they fill it out, you mail it in and then the DMV will mail your sticker and it's free in most states! How easy, right?

5) SOME insurance providers will pay for an Autism Service Dog. If they do not there are grants available. You can always Google "Autism Service Dog"


A medicaid waiver is something that every state offers. It's basically for those that do not meet the income guidelines for Medicaid but have a Special Needs Child. The waiting list can sometimes be lengthy so it's important to apply as soon as you can. You can also have Private Insurance AND still qualify for the Waiver program and Medicaid will cover what your Insurance will not =) This waiver will cover most of what general medicaid does, OT, PT, SLP, Rx's, interactive gadgets that your child may need to communicate and so on.

Here is a great link that will list what your State Insurance is required to cover:

-Click on the link below
-Click on your State
-Once on your state scroll all the way down to see what is covered.

What Does My State Insurance Cover Link

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