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.  

Little Star Center staff shares their thoughts about autism for Autism Awareness Month

During Autism Awareness Month, members of Little Star Center’s staff shared their thoughts about autism by completing the sentence, “One thing I want people to know about autism is ……..” Here’s what they shared:

“…that it does not mean a child’s life cannot have meaning.” ~ Shelly

“…the prevalence rate is 1 in 68 people.” ~ Taylor

“…that a diagnosis does not define a person.” ~ Angela

“…it is not an excuse for poor behavior.” ~ Mary

” …that each child is unique and has their own personality.” ~ Shaina

“…kids with autism grow up to be adults with autism and older adults with autism. Transition planning is crucial.” ~ Lindsay B

“….ABA helps individuals across the entire spectrum to maximize their independence, fulfillment, and enjoyment of their life.” ~ Tim

“…that autism is a spectrum and not all children with ASD are the same.” ~ Victoria

“…if you’ve met one person with autism…you’ve met one person with autism!” ~ Vince

“…that it doesn’t always make you anti-social, doesn’t make you quiet, doesn’t make you a math-genius, and it doesn’t make you unable to speak.  Just like anyone off the spectrum, people diagnosed with autism come in all shapes and sizes and have their own unique interests and skills that make them wonderfully interesting individuals.” ~ Casey

“…everyone can learn, we just may need to change the way we teach.” ~ Amanda

“…..it is a neurological or biological disorder.  It is not a psychological condition.” ~ Carrie

“….it is not a limiting diagnosis.” ~ Meg

“…..autism is not just one thing.” ~ Beth

“….it’s a spectrum disorder therefore each case is different; each child displays different strengthens and challenges.” ~ Brooke

“….that not all kids with autism are non-vocal, in fact a lot of kiddos with autism are very vocal.” ~ Kaitlyn

“…communication comes in many forms.” ~ Kasey

“…that every kid has a unique way of learning.” ~ Jackie

“…even if they cannot speak, they are still listening!” ~ Ashley

 

 

 

 

 

 

“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.

Dear Mary, July 13, 2012

Dear Mary is a bimonthly column whereby readers may submit questions to [email protected] and receive answers related to autism.  Mary Rosswurm is executive director of Little Star Center and also the mother of a son who has been diagnosed with autism.  She understands…

Dear Mary,

My son’s doctor recommended ABA therapy for him. He is four years old and doesn’t like loud places, lights on or other kids. I would like a home program for him.

Jeana, Indianapolis

 

Hi Jeana,

The reasons you described (dislike of loud places, lights or other children) strongly suggest why your son needs a center-based program and not a home-based program. A robust center-based program offers access to other children, a variety of staff, the speech therapist, occupational therapist, outings, group activities and multiple layers of supervisors. Since your son is four, the goal is to get him prepared for kindergarten, and it will be essential that he can tolerate noise, lights and other people. Addressing these concerns require clinical expertise and closely monitored programming.

While I know that as a mom you want to make your child comfortable — and he may be more comfortable at home with one familiar person working with him each day — that is not real life. He needs to be able to be around new people, in novel situations. Let’s face it – the world is bright, loud and full of kids. As he gets older, he will become more and more isolated if we don’t begin to get him used to these things.

For example, two years ago I was terrified of the iPhone – I had my old flip phone and I didn’t want to learn about this new kind of phone. It seemed very complicated to me and I didn’t see why I needed access to my email or the Internet constantly. I really resisted it until finally my supervisor insisted that I get one. Period, end of story.

So, at first I HATED it. I dropped calls all the time and couldn’t figure out how to turn the stupid thing off while I was on a plane that was heading for take off. I couldn’t work the tiny key pad (that wasn’t even real keys) and every time I tried to hit the “M” key, I would hit the “backspace” instead. I hated it and I was miserable. BUT…the more I used it, the better I got and I learned new things about it everyday. My co-workers would gently encourage me to try new features like the GPS or face-time.

Now two years later, I can’t imagine how I lived without it. I am comfortable with it. It simply was a new skill that I needed to learn, which is exactly what these obstacles are for your son – things he needs to learn to tolerate. It will take time, he may be upset at first, but he will get comfortable and be able to be around these things that he finds annoying right now. Don’t lose sight of the big picture – where do you want him to be when he is 8, 12, 15 and 30? Not home alone, but out with people in different places.

I would encourage you to look at a center-based program for your son and stretch his comfort zone!

Mary,

Executive Director, Little Star Center

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.

 

Ground Gained in Autism Insurance Laws

Little Star Center Executive Director Mary Rosswurm’s guest column, “Ground Gained in Autism Insurance Laws”, appeared in the April 30, 2012 issue of the Journal & Courier, Lafayette-West Lafayette, Indiana.  It is reprinted below.

Every family wants the best for their children. That desire is even stronger when parents learn their child has autism.

Thankfully, we live in a state that understands that the best treatment for this fast-growing neurological disorder shouldn’t be limited to those who can afford it.

As we recognize National Autism Awareness Month, I believe it’s important to acknowledge the groundbreaking efforts in Indiana to pass a law requiring health insurers, with some exceptions, to cover intensive therapy for autism, regardless of age or time in treatment. 

This mandate — passed in 2001, five years before any other state – reaffirms that autism is a medical diagnosis that requires treatment just like any other health issue.  More importantly, many Hoosier families have more autism therapy options for their children without the added stress of struggling to cover costs.

Indiana  families are in a unique group, as 27 of the 28 other states with autism health insurance mandates cap the amount of annual treatment a person can receive, as well as the age of the person being treated.  Massachusetts passed a similar law to Indiana’s in 2011.

Indiana’s Health Insurance Mandate for Autism Spectrum Disorders and Pervasive Developmental Disorders law increases access to proven successful therapy such as applied behavior analysis, once limited to those who could afford to pay out of pocket.  This therapy is a highly researched approach to teaching children with autism appropriate social, communication and life skills critical to helping them lead productive lives.

Little Star Center was the first center to offer applied behavior analysis when it opened in 2002. Ten families enrolled, with all paying the treatment costs personally.  Enrollment has increased steadily at both the Carmel and Lafayette facilities; the Lafayette center opened in 2011.

The treatment cost for nearly all those enrolled is covered by health insurance. Our enrollment now includes families from diverse economic backgrounds, thanks to Indiana’s mandate.

Each day, we celebrate with our families as their son or daughter achieves success through this proven therapy. Our accomplishment feels even more complete knowing that many of those enrolled would have been unable to benefit from this treatment if not for Indiana’s law.

Yes, there are restrictions to the law. Self-insured companies and employers not based in Indiana are not required to follow the mandate. Medicaid and Hoosier Healthwise are not required to follow the mandate, either.

Although it’s not a perfect system, more families now have access to effective and research-based treatments that were once out of reach.

This accomplishment alone sends a powerful message to families that Indiana stands with them in their search for the best autism treatment for their child, period.

Mary Rosswurm is executive director of Little Star Centers in Carmel and Lafayette.  She serves on the Indiana Commission for Autism and is mother of a young adult with autism.

 

 

 

Little Star Center to Receive Excellence in Direct Care Award – Official Press Release

Press Release – FOR IMMEDIATE RELEASE

Contact: Amanda Ryan

Community Outreach & Marketing Director

317.249.2242 | [email protected]

Little Star Center to Receive Excellence in Direct Care Award

Autism Society of Indiana to Hold 2011 Excellence Awards

CARMEL, IN, July 26, 2011 – Little Star Center, a non-profit center for children with autism, will receive Autism Society of Indiana’s (ASI) Excellence in Direct Care Award. The award is for providers who demonstrate excellence in direct care services to infant, toddlers, children, youth, and adults with ASD (Autism Spectrum Disorder) through their work in medical, educational, therapeutic, recreational or other settings using innovative and scientifically supported best practices in partnership with families and other professionals.

Little Star received nominations from parents, civic leaders and community members.

“We are so honored to receive this award and be recognized by the ASI. It is even more meaningful to be the first center to ever win this award,” says Mary Rosswurm, Executive Director of Little Star Center.

Based on the principles of Applied Behavior Analysis (ABA), Little Star provides an atmosphere where children, therapists and families can interact, support each other and receive on-going training so that each child can reach their full potential at home and in a variety of settings outside of therapy. After decades of research, the United States Surgeon General has endorsed intensive behavioral intervention for individuals with autism as the treatment of choice. Over 50 years of research documents the efficacy of ABA in reducing inappropriate behavior and increasing communication and learning.

The 2011 Excellence Awards will be held on Saturday, August 20th, 2011 at 6:30 p.m. at the home of Tim and Kim Earnest in Zionsville. For more information and to buy tickets for the event, please visit www.inautism.org for more information.

About Little Star Center

Little Star Center was founded in 2002 and was the first center in the state of Indiana to serve children with autism. Little Star has two locations, in Carmel and Lafayette. Little Star is a truly unique and special place for children and families living with autism. Little Star allows families to have the best of both worlds – the intense one-on-one personalized therapy that used to only be available in a home program and the community feel of a center based program that allows children with autism access to peers, materials and a beautiful facility. Families are an integral part of their child’s programming along with Little Star’s staff of professionals. Little Star prides itself on having a “family first” philosophy. For more information please call 317.249.2242 or visit us on the web at www.littlestarcenter.org.

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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!