When Insurance Won't Pay

The Politics of Autism includes an extensive discussion of insurance legislation in the states.

Lynne Adkins reports at KYW-AM:

Advocates have been pressing insurance companies to pay for medicines taken by autistic subscribers, and currently people in 43 states are now benefiting according to Judith Ursitti, Director of State Government Affairs for Autism Speaks. She says if you’re left with the bill, there are options.

“You can look at the marketplace plans under Obamacare in your state too, if you go to healthcare.gov. Most of those do require coverage for pharmacy care for autism spectrum disorder,” said Ursitti.

An alternative is to challenge the insurance company’s refusal to pay by filing a complaint with your state’s Department of Insurance.

Alexandra Carter reports at WHNT-TV:

Alabama is one of just seven states that does not mandate insurance coverage for autism therapies. The recommended therapy can cost families upwards of $60,000 per year.
Applied Behavior Analysis or ABA is the gold standard for autism therapy, recommended by doctors, specialists and insurance companies.

"They need it for everyday life, they need it for when they get older if they want jobs or families of their own, to go to college. This therapy helps them achieve those goals," said Summer Stewart, mother of Eli, a child with autism.

The only problem is, ABA therapy is expensive and in Alabama, not covered by insurance, which means families must pay out of pocket.

"To our family it's like having two additional mortgage payments every month," said Eli's dad Brian.