Recently, I was sent a booklet of information that included several changes that had been made to my new health insurance policy. One of those changes is excellent news for parents of kids who have autism, and who live in California. Soon, insurers are going to be required to cover ABA!
As of July 1, 2012, California law requires all individual health insurance plans to provide coverage for certain behavioral health treatments for pervasive developmental disorder or autism. My insurance company recently sent me a booklet that included information about this change to my health insurance coverage, (as well as several other nice changes).
It is one thing to read a news story that says that California has worked out the laws that require health insurance companies to cover ABA. That is good news! Somehow, though, it feels more real when I have it in print, in my hands, in a booklet from my insurer.
My insurer will cover ABA if it is administered by “Qualified Autism Service Providers who may supervise and employ Qualified Autism Service Paraprofessionals or Paraprofessionals who provide and administer Behavioral Health Treatment to a provider that has contracted with Anthem”. Anthem is the name of my insurer. It is common for insurers to only cover treatment that comes from providers who they have contracted with, (no matter what that treatment is).
There is a whole section that gives very specific details about what Anthem considers to be a Qualified Autism Service Provider. The booklet defines Behavioral Health Treatment as “professional services and treatment programs, including Applied Behavioral Analysis and evidence-based behavior intervention programs, that develop and restore, to the maximum extent practicable, the functioning of an individual with Pervasive Developmental Disorder or Autism”. This is followed by a list of criteria that must be met in order for it to be covered.
It also has a definition for Pervasive Developmental Disorders”. They “are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests, or activities. The qualitative impairments that define these conditions are distinctly deviant relative to the individual’s developmental level or mental age. These disorders include: Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.”
Image by Candie_N on Flickr