ABA therapy and insurance: What you need to know

Many families with children affected by autism are currently reviewing insurance options during the Affordable Care Act open enrollment process. Here are four things to keep in mind as you consider ABA therapy and insurance:

ABA therapy insurance coverage is different with each policy. Coverage is dependent on whether your employer is self-funded or fully funded. Your prospective ABA center should contact your insurance provider to determine if ABA therapy is a covered benefit and what co-insurance/co-pay is applicable to your policy. Little Star Center accepts most insurance plans and, with the assistance of our family services director, works closely with families to address policy issues.

If your insurance plan does not cover ABA therapy, we encourage you to speak to an insurance broker familiar with the treatment and specific insurance need. It is important to work closely with your prospective center and insurance broker during open enrollment to ensure adequate coverage. Please remember open enrollment closes Jan. 31, 2016. After this deadline, insurance policies and rates are locked in until the next enrollment cycle.

Once insurance coverage is verified, your child’s start date for enrollment will be set. At Little Star Center, we have a step-by-step process that takes two to three weeks to complete and will ensure insurance coverage is in place for services.

If you do not have insurance, please contact an insurance broker who can assist you with options for ABA therapy coverage.

Remember these important dates during open enrollment:

  • December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016
  • January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15
  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016

To learn more about ABA therapy and insurance coverage, visit the following websites:

Written by Victoria Blessing-Wade, Family Services Director at Little Star Center. Email Victoria at [email protected] with any questions about enrolling at Little Star Center.  

“An inability to express one’s self in accordance with society’s standards does not make you less, it just makes you different.”

Written by a Little Star Center employee

I grew up with my older brother.  Mom, dad, me and my brother.  We were as close as two brothers could be growing up.  My mom stayed home with us until we went to school.  Everything was very typical, I didn’t know any different.  We would play blocks, trucks, roughhousing and make believe.  It wasn’t until my brother left for kindergarten.  I remember walking with mom to the bus stop and watching my brother get on the bus for school.

I was sad at first. This was the first time I would be away from my brother ever, at all.  I learned later in life that when my brother went to school, a different side of him was shown.  My brother, who played with me like a typical kid, didn’t play with anyone in kindergarten.  In fact, my brother didn’t do much of anything.  He sat in a corner, away from all of his peers.  My brother displayed his first signs of Asperger Syndrome, extreme social anxiety in a new setting.

I didn’t know when he got home that he had such a rough time at school.  He was my brother like I always knew him, back in the safety and security of our home.  My parents were made aware of his difficulties, and he repeated kindergarten.  My brother, being the brilliant human being that he is, surely saw that he didn’t meet their social expectations year one, so made sure of it come year two.  My brother progressed into elementary school as if nothing was wrong.  He did well academically and even made a handful of friends, some of which he still has to this day.

It wasn’t until late elementary school that a teacher noticed some of my brother’s difficulties and suggested that he be tested for high-functioning autism.  In the mid 90’s my brother was diagnosed with Asperger Syndrome.  This was difficult for me to hear, as you could imagine, being a 10 year-old boy and hearing your brother has a**burgers?  I was quickly told the correct spelling and was told that it was a high functioning form of autism.

We went to a parent meeting one evening at our elementary school so my parents could receive some literature on my brother’s newly discovered syndrome.  My brother and I played in the gym with some of the others kids and siblings.  We quickly noticed how out of place we were.  My brother was not like these children, we could both see that.  After that night, little was said about my brother’s Asperger’s or about the fact that he had autism.  But my curiosity had been peaked.  My brother was always just a little quirky and odd to me.  It never was anything deficient about him.  In fact, I always admired his ability to block out social distractions and focus on his studies and academic pursuits.

I was curious and, as it turned out, I would spend the rest of my time in school taking every psychology class I could get my hands on. I studied psychology in college as well as counseling and philosophy.  I wanted to help others and change the world.

After college, life sent me to residential care for children with autism.  I finally felt as though I had answered my calling.  I was working with a population I had been around my whole life.  Little did I realize that my brother was very similar to the kids in that gymnasium all those years ago.  Just a little quirky and different when it came to communicating with others.  But just as brilliant and loving as my brother.  I love my brother and this lesson that he taught me so early in life:  An inability to express one’s self in accordance with society’s standards does not make you less, it just makes you different.  It has been my pleasure working with children with autism and helping the world see their brilliance and love, even if it’s not what they’re expecting to see.  And I have my brother to thank for that.

This post was written by an employee at Little Star Center who has requested to remain anonymous.

Young student is a fan of Little Star Center

William, the 10 year-old son of Tim Courtney, research and training director at Little Star Center, wrote the following letter to his school to request a grant for Little Star Center. This is a great reminder that our learners  success is important to even our youngest citizens.

Did you know one out of every 88 kids has autism? It’s for that reason I think we should choose Little Star Center for one of our lollipop drop charities.

Little Star Center is right here in our community helping kids with autism. Little Star is 100 percent non-profit. With the money we raise for (the school), it would be able to purchase therapy supplies for the kids who go there. The supplies would help the kids in learning to communicate and be independent.

I think it’s important to help everyone as much as we can, and it’s a great feeling to be able to help kids in our very own community. My dad is one of the directors at Little Star Center. I know the work they do is changing kid’s lives, and I hope we can assist them in continuing to do that.

Temple Grandin’s “Bright Not Broken”

Great article you may have missed!  Temple Grandin is wonderful…  The Coffee Klatch blog on “Bright Not Broken.”

 

Autism Speaks Hails Landmark Federal Decision Calling Key Autism Therapy a ‘Medical’ Service Eligible for Insurance

Michele Trivedi, Little Star Board member and volunteer health insurance advocate, is an active member of the autism community, volunteers with the Autism Society of Indiana (ASI), the Indiana Resource Center for Autism (IRCA,) and Autism Speaks to promote health insurance coverage for autism across the country. Michele shares her thoughts about the recent landmark federal decision on autism therapy insurance coverage:

“We are very fortunate in Indiana, that through the advocacy of parents, IRCA, ASI and the Autism Research Centre (ARC), our state legislature recognized more than a decade ago that autism is a treatable neurological condition.  It also acknowledged that Applied Behavior Analysis (ABA) is a medical treatment for autism, when our Indiana Health Insurance Mandate was passed in 2000.

The recent decision by the federal government, noted in the Autism Speaks article, though not binding, will help all people with autism who do not currently have the benefit of health insurance coverage for autism by making it much more difficult for health insurance companies to claim that ABA is an “educational” program and not a medical treatment.  This will help families in Employee Retirement Income Security Act (ERISA) health plans (federally regulated health plans) to advocate for autism coverage.

Little Star Center has always been at the forefront in the efforts to advocate for insurance coverage for ABA therapy and will continue to assist in efforts to ensure that all children have access to quality ABA services and quality ABA health insurance coverage. We look forward to continuing to work with organizations like ASI, IRCA, the ARC and Autism Speaks.”

Michele serves on the Health Benefits Mandate Task Force for Indiana (appointed by Governor Daniels) and was appointed in 2002 by the Commissioner of the Indiana Department of Insurance to represent the autism community on health insurance issues for the development of Bulletin 136, which mandates insurance coverage for autism spectrum disorders.  She earned a Masters of Science degree in Health Services Administration from Xavier University.

She donates her time to assist fellow Hoosiers with insurance-related issues. Her daughter, Ellie, was the “test case” for the enforcement of the Indiana Autism Mandate.

 

Some Great Reading Material When the Weather has you Stuck Inside – The Latest Autism Topics and Research: ASAT Newsletter Winter 2011

Hi Everyone,

Hope you are warm and your schedule is back to normal after all the crazy weather last week.  Little Star Center was closed three days due to ice and snow, but we are back and ready to roll.

This morning, when I sat down at my desk, I was excited to see I had the latest edition of the ASAT Newsletter in Inbox.  My favorite part is Media Watch – a section where Association for Science in Treatment of Autism (ASAT) responds to both accurate and inaccurate portrayals of autism intervention in the media.

This quarter, there are also three research article summaries – examining hyberbaric oxygen therapy, the use of weighted vests and a manualized DIR parent training approach to treatment.

Also, check out page six for our latest ad!

Happy reading and enjoy the sunshine today!