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Hi...some insight needed please.

T

tye

New Member
Hello all,

My name is Tye and I just joined the forum today. I was not diagnosed with A, but my 3.5 year old son was. He is on the "lighter" side of the spectrum and fully functional, but it still gets extremely difficult at times.

Anyways, the reason I am here is bc I'm hoping someone can provide some insight on how Autism is covered by insurance companies. I know the state of Georgia passed a law mandating that all autism related therapies (speech, occupational, ABA) be covered by the insurance company. However, I am currently being told that I have to meet my deductible before the copay kicks in (I am on the PPO plan). Is anyone else in this same circumstance? I just feel that the insurance company is abusing a loophole in that Autism is being covered technically, but the deductible has to be met first (on a PPO plan!!!).

I just need to need to confirm if this is correct, or if "covered by law" means that it should be covered at 100% regardless of the plan. I have done some extensive searches online, but cant find anything about deductibles and autism specifically.

Any help would be greatly appreciated.

Thank you in advance.

Tye
 
If you've not used your insurance at all this year and haven't met it's deductible then probably will have to IF your plan has a deductible. Check your policy- I don't think they can charge an additional deductible for autism but maybe there is a deductible for each family member which has to be met. I think covered by law just usually means they have to include autism as a covered condition. Whether or not there's a deductible depends on the policy you have. You can call the insurance company to ask how, in general , the deductible works.
 
Thanks for the reply Lucy. This is actually for 2018, so the plan hasn't technically kicked in yet.

"I think covered by law just usually means they have to include autism as a covered condition. Whether or not there's a deductible depends on the policy you have."

Exactly what I was looking for. Just wish I knew for sure.

Thanks!
 
An excellent question IMO given how the actual legislation reads. When I read it, I can only say that I see provisions pertaining to coverage- but not necessarily your policy's contractual terms and conditions of what is required to maintain your insurance coverage.

https://www.oci.ga.gov/ExternalReso...es/AutismSpectrumDisorder/OCGA33-24-59.10.pdf

Under such circumstances I think your best choice of action would be to contact your nearest constituent services representative regarding the office of Attorney General. I can't guarantee as to what kind of response you'll get from them, but it's the first source I'd try over the phone at no cost.

And be sure to document who you spoke to, their title and the date/time you called.
 
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