from WAA - preparing for mental health parity 7/1/10, will it work for autism?
April 19, 2010
Is Autism treatable? Is the treatment attainable and widely accessible? Are highly trained and competent treatment providers covered by insurance companies and Medicaid?
With scientific advances in the last decade promising treatments have emerged and are gaining national attention. Yet the payers (insurance carriers and self-funded plans managed by insurance carriers) continue to arm themselves with old, carefully selected misrepresenations of the truth that autism is treatable and these treatments are attributing to better outcomes for patients with ASD’s.
For this reason, 18 states have now passed laws that ban specific policy exclusions of autism treatments and require coverage of evidence based diagnosis, develpment of treatment plans and the treatments by private insurance.
In Washington State, Full Mental Health Parity will become LAW on 7/1/2010. Mental Health Parity covers medically necessarty treatments for individuals with a DSM diagnosis for life, with the same dollar cap as medical & surgical benefits.
After that if evidence based diagnosis and treatment is still being denied, then the law has to be court tested. You may have read about class action lawsuits that have required insurance to cover autism. Several prominent WA attorneys have expressed serious interest in testing out WA’s Mental Health Parity in courts. If you’re insurance is denying treatment that is prescribed and found to be medically necessary to treat autism, this may be of interest to you. Please get the denials in writing, ask a lot of questions:
- Is the treatment being denied by XYZ or is it not included in my employers plan?
- Is the treatment covered for other conditions?
- Is the treatment covered for patients who are not insured through XYZ company?
Ask them to put all the information in writing, if they refuse, get their contact information, you put in writing what they told you & send it to them. You need a paper trail for any appeals or other action. Keep a separate folder with all these records.
Please distribute this information to your local listserves and among those with ASD’s. Insurers have worked hard to create barriers to assure minimum payouts on claims. Consumers will have to be well informed and know their rights.
All my best,
Arzu Forough
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