Question regarding insurance bill

[Guest guest]

Good question -- another question to ask is when will it actually take

effect on the insurance industry.

Open enrollment is usually December for most companies and a currently

negotiated plan stays in effect until the end of December. If they are not

forced to cover it immediately (or in September if that is the effective

date of the bill) then most likely it would not even take place until

January, even if your company decided to offer the coverage.

Vickie

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From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of Kendra

Sent: Wednesday, May 30, 2007 9:02 AM

To: Texas-Autism-Advocacy

Subject: Question regarding insurance bill

As things are right now I will only have a few short months to take

advantage of this new bill, my daughter will turn six at the end of

next January...so I need to get my ducks in a row now. My question

is... all though the insurance companies are going to be required to

cover the therapies listing in the bill, will big companies have to

provide those " services " to their employees within the company health

insurance policy in Texas?

The reason I ask this question is that in Texas insurance companies are

required to offer coverage for infertility treatments. However,

companies do not have to then select those infertility treatments as

part of the package they offer their employees.

Thanks

Kendra

[Guest guest]

Good question -- another question to ask is when will it actually take

effect on the insurance industry.

Open enrollment is usually December for most companies and a currently

negotiated plan stays in effect until the end of December. If they are not

forced to cover it immediately (or in September if that is the effective

date of the bill) then most likely it would not even take place until

January, even if your company decided to offer the coverage.

Vickie

_____

From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of Kendra

Sent: Wednesday, May 30, 2007 9:02 AM

To: Texas-Autism-Advocacy

Subject: Question regarding insurance bill

As things are right now I will only have a few short months to take

advantage of this new bill, my daughter will turn six at the end of

next January...so I need to get my ducks in a row now. My question

is... all though the insurance companies are going to be required to

cover the therapies listing in the bill, will big companies have to

provide those " services " to their employees within the company health

insurance policy in Texas?

The reason I ask this question is that in Texas insurance companies are

required to offer coverage for infertility treatments. However,

companies do not have to then select those infertility treatments as

part of the package they offer their employees.

Thanks

Kendra

[Guest guest]

The effective date of the bill is January 1, 2008, so it is the

beginning of next year.

You are also correct when you say not all companies have to offer the

plan. How many of you are aware that your company is SUPPOSED to

offer " mandate free " policies? I never knew it before until we got

into all this insurance bill stuff. Even most of the legislators didn't

even know it, and they passed it several sessions ago! Needless to say,

I don't think most companies in Texas are even aware of this law.

Unfortunately, this bill will not cover " self funded " plans that

companies provide, either, because then it is your employer who decides

what will be offered on the plan and what will not. Those plans are

governed by ERISA laws, which are federal. And, federal law always

supercedes state law.

Every year, BEFORE when it was time to start reviewing policies to make

a selection, my husband and I were always very proactive and went to

the benefits dept. of his company and had a conference with the big

wigs in benefits and top company officials to tell them what we really

needed in our plan (he has always worked in big corporations where

often this isn't even the main location). Then we would have another

meeting (usually a conference call) with the insurance company execs

and the benefits people at my husband's company once we chose a policy

to ensure that we would not encounter problem after problem. Often we

ended up being appointed a " case manager " at the insurance company who

would make sure all our claims were handled appropriately and with few

or no problems.

Although we never tried to get ABA paid for, we were always successful

at getting pretty much everything else covered. We have been insured in

the past by companies like Aetna, United Healthcare, Cigna (they were

the hardest to deal with...and since they are an HMO, they actually DO

fall under the state rules but I had to file multiple complaints to the

State Board of Insurance to get them to pay for things they had even

approved!), and several other big companies.

So...my advice is to do your homework and REALLY check with your

employer about their policy. Go the extra mile and get things in

writing. Ask to see an actual copy of the POLICY (not just the benefits

summary they usually give) to see what is and is not covered on your

plan. Really get familiar with what you are paying for. It is alot of

effort, but the effort pays for itself. I used to joke that my other

full time job (besides each child, who was a full time job in and of

themselves) and the laundry (another full time job) my OTHER full time

job was taking care of our insurance claims!

But...we always got everything paid for, and we got special permissions

to go out of network, get blood draws at places other than the one size

fits all lab, etc. and still get it paid for.

[Guest guest]

More bad news is: If your company is self-funded, like

ours (GE), then they are not bound to comply with the

laws because the insurance company is merely

administrating their self-authored plans. Self-funded

plans aren't included, because the language is not in

there....we will have to wait for 2 years for that!

Sadly, Bob (AutismSpeaks) is the former CEO and

is an acitve board member at G.E., yet they have the

worst coverage for the needs of families effected by

autism....typical 20 visits a year for Speech and OT

and NONE for ABA. You'd certainly thing that the

s would set and example, but it seems to be more

" do as I say, not as I do " .

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[Guest guest]

--- nna Bond wrote:

> Those plans are governed by ERISA laws, which are

> federal. And, federal law always supercedes state

law.

>

Hmmmm. Didn't the federal government just pass a law

that mandated insurance coverage for autism?

>

http://www.autism-pdd.net/testdump/test14088.htm

Hmmm that doesn't mention insurance though I thought

it was in there somewhere.

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[Guest guest]

Correct, ERISA- most people aren't familiar with that

term unless they are an attorney. But, it's tough

when SO many companies are self-funded. You have hope

when you hear that it may be mandated but it does not

apply to most large employers. No, I don't believe

that there is not a federal law YET that requires the

coverage....thus the multiple struggles addressed

here, I guess. Maybe someday

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[Guest guest]

This is such great advice. I am going thru this right

now with GE. As I stated before, you'd think that

they would be FABULOUS when it comes to coverage for

our needs, but neither medical administrator will

really engage in a conversation with me about coverage

options until I have an ID number, but I am not

certain which company we wanted to go with until I

knew what they would and wouldn't pay for. It's a

vicous cycle that I can't seem to get out of.

I have even been in talks with Bob and Suzanne s

personal assitant to ask why they aren't setting an

example with GE by doing what they are asking the

government to REQUIRE employers to do!

Any ideas how to make progress with coporate? How did

you get to speak to the right person? I've been doing

this for 4 weeks now and all I get is sent to " Cigna

Behavioral! " It's very frustrating!

Thanks !!!

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[Guest guest]

Thanks for everyone's input and clarification!! Chevron has gotten rid

of their department where we could have gone to make complaints about

their health insurance, talk about a smart way of getting out things.

Kendra