Tuesday, April 2, 2013

Autism Insurance Coverage at Michigan State

1 comment

On March 29th, 2012 three public acts were passed (Public Act 99, 100, & 101) affecting insurance coverage of autism in Michigan. These three acts established a mandate for insurance companies to provide insurance coverage for children with a medical diagnosis on the Autism Spectrum Disorder (Asperger, PDD-NOS, or Autism). It established a tiered system that covered autism diagnosis, pharmaceuticals, psychiatric, psychological, and therapeutic services (speech, occupational, applied behavior analysis, physical therapies; and social workers).
· Children up to 6 years of age are eligible for up to $50,000.00 annually. 
· Children 7 through 12 years are eligible for up to $40,000 annually 
· Children 13 through 18 years are eligible for up to $30,000 annually.
These laws reflect an obvious consensus in Michigan that children on the Spectrum are deserving of the treatment afforded to other medical conditions. However these laws are not applicable to companies who are “self-insured” because companies that are self-insured are governed by federal laws. Knowing this, one of the three acts established a $15 million dollar insurance fund to reimburse self-funded insurance companies and encourage them to provide autism coverage.
Michigan State University is a self-insured company and thus is not legally required under any present laws to provide Autism insurance coverage. MSU’s current insurance providers presently treat Autism as an exclusionary factor for any therapeutic treatment and will deny any requests for therapeutic services if Autism is provided as a diagnostic reason.**

Let me say that again in case you missed it.  MSU's current insurance EXCLUDES any treatment for therapeutic services 
(speech therapy, occupational therapy, physical therapy etc) if Autism or any other developmental disability (including Fragile X) is listed as a reason for service.  

For us, as a family insured by Michigan State (where Mr Awesome is employeed) this means that Ayden receives all his services through our public school.  Out of pocket costs for a one hour session of his speech therapy run about $400.  At Ayden's current level of speech, he is recommended to receive 2 hours per week of speech therapy in addition to what he receives at school.  For those of you bad at math...that would mean $41,600 in JUST speech therapy per year.  That number doesn't even being to account for the occupational therapy he also needs. 

Over on the right hand side of this blog (and listed at the bottom of this post) there is a link for a petition to help promote receiving this coverage in our health insurance plans.  You do not need to be affiliated with MSU to sign the petition -- your signature just means you support adding this type of coverage for employees and families at the university that could benefit from this coverage.  Please take a minute to read over this petition and sign if you feel so obliged.  

**All wording before the double asterisk was taken from the petition directly.

Sign the petition for Autism Insurance Coverage at MSU

1 comment:

  1. Recently found this blog about insurance. Gives great information about insurance.
    Rochelle Dsilva