RE: Re: Insurance Company Drama

[Guest guest]

It is not really a loophole in the state law but it is a federal law that states that self-insured companies are exempt from state insurance regulations. This is true for every state in the union. There has been some discussion of whtther it is possible to get coverage under the federal mental health legislation. Also it should be noted that employers with less than 50 eployees are also exept.

Of course it can be said that these companies could cover autism if they were to choose to do so. It is the squeekie wheel that gets oiled, if you knw what I mean.

To: sList From: sandra.feldman@...Date: Sun, 2 Aug 2009 17:50:23 -0400Subject: RE: Re: Insurance Company Drama

,

Just note that just because you have health insurance does not mean that your insurance plan is part of the Autism "ABA" coverage. Some loopholes is an understatement. If you have insurance through your employer does not mean you are eligible. you need to find out from your HR department if your company is "Self - Insured" or not,this term in your policy makes a difference, and if that is the case you will get very few hrs if any for ABA. Unless your policy states that it is "Fully Insured Policy" your not going to get the $36,000.00 a year coverage, deductable or no deductable. The Law has this specific loophole that makes it impossible for anyone to just start cashing in on this wonderful coverage. Not many companies choose Fully Insured over Self Insured due to the higher cost to employers.

Until an amendment is made to this New Law we are still going to have to fight for ABA.

Mother Warrior to Samwww.makingautisticstrides.com

From: sList [mailto:sList ] On Behalf Of ostinho2Sent: Monday, August 03, 2009 3:26 PMTo: sList Subject: Re: Insurance Company Drama

You shouldn't be dealing with any deductibles unless the provider is out-of-network. If they take your insurance, all you're responsible for is the session co-payment. If the provider is out of the network, you normally have to meet your deductible first, and after that the plan pays a set percentage of the "costumary charge" for that particular therapy.There's some loopholes, for example for ABA, since our plan doesn't have any provider in their network they're treating ours as if she were IN the network, meaning, we don't have to meet our deductible, just pay the co-payment each session. But for Speech it's different, since they have several in their network, our deductible applies.Call your insurance to make sure you're eligible for coverage, the law went into effect January 2009, but only for policies new or renewed on or after April 2009.Good luck,>> Hi, I have 2 children on the spectrum, both need services, but my new insurance company is telling me that we have to first meet the $3700.00 deductible before they will cover any OT etc. Does anyone have information regarding the Insurance act which is supposed to pay for services due to Autism?. I would appreciate any information.> > Thanks so much,> > >

Get back to school stuff for them and cashback for you. Try BingT now.