Re: Re: Insurance coverage denial as a result of our new Autism Law??

[Guest guest]

Thank you, for sharing some excellent information.

You are so right...knowledge is power...

Perhaps we can find an insurance expert, such as the person I referenced, Gail

Borgerd as a Guest Expert, in the new future.

Ellen

Ellen Garber Bronfeld

egskb@...

Re: Insurance coverage denial as a result of our new

Autism Law??

I just happened to be scanning through and thought I would comment. I

want others to benefit from my past experiences so that we all don't

have to suffer the consequences of " not knowing " something ahead of

time.

I have a 14 year old son who was born prematurely, and therefore, had

many chronic health issues in addition to his other diagnoses. As a

single parent, I had to do much research to advocate for him regarding

health insurance, the ADA guidelines for day care centers, etc. It

is always the fine print that is the problem. Even with the ADA, I

found that it " wrote you in " , and then " wrote you right back out " in

many instances, due to exclusions.

Although this may not be the case in your situation, this will be a

problem for many people and something that is not well known until it

happens to you. I have copied and pasted the important details from

the new law from a previous post.

The Autism Law Does Not Apply to:

o Self-insured, non-public employers.

o Self-insured health and welfare plans, such as union plans.

o Insurance policies or trusts issued in other states.

You may not realize it, but many companies are " self-insured " . They

insure themselves and then hire an insurance company to " administer "

their health and welfare benefits. Many large companies are self-

insured.

Self-insured companies are what I like to call " above the law. " They

don't have to abide by the Illinois insurance code, and that's a

fact. What we really need to advocate for is equal insurance for all.

Many families run into this problem when they are self-employed and

trying to purchase private healthcare coverage for their family. They

will find that their child with a " disability " is denied coverage

based solely on " the disability " . These insurance companies do not

have to accept everyone, and those that do will charge a hefty premium

that most cannot afford.

So this new " Autism Insurance Law " is really only a victory for a

small few. It will probably cause more people/families to lose their

healthcare coverage than it will actually help others.

IF YOUR EMPLOYER FALLS INTO THE ABOVE CATEGORIES, THE LAW WILL NOT

APPLY TO YOU!!!!!!

Also, keep HIPPA in mind. This is not just a " privacy act " , it stands

for " Health Insurance Privacy and Portability Act " . The portability

piece is important. If you go one single day without health insurance

coverage, your next health insurance provider can place " pre-existing

condition " restrictions on you. Make sure if you leave a job that you

take the COBRA health insurance if you can afford to do so. Do what

you can to make sure there is not a gap. Another fact that will help

people is the fact that Medicaid is health insurance coverage. So, if

you lose your private health insurance, but still are covered by

Medicaid, you have not had a gap in coverage.

I recommend that families try to keep their family member on their

private health care plan for as long as possible, because fewer and

fewer doctors (especially specialists) are accepting Medicaid.

Check to see if your employer is self-insured or if your health plan

is self-insured (your Human Resources Dept. should be able to provide

that information.) If they are, they are above the law. If they are

not, then the Illinois Insurance Code should apply. There is a law in

Illinois which would allow employees to continue to cover their adult

son/daughter on their health plan if the dependent has a disability.

You must request this in writing at least 60 days prior to the date

that their coverage would typically end (when they are no longer a

full-time student, or reach a certain age, etc.)

Another FYI, your son/daughter with a disability will become eligible

for Medicare (healthcare) 24 months after one of their parents A.

Retires B. Becomes disabled C. Is deceased. This means that they

may be eligible for Medicare before the age of 65 (or whatever the

age is now, seems to be a moving target).

My advice to everyone is that KNOWLEDGE IS POWER and to seek

professional assistance before any changes come up with health

insurance, assets, etc. Other parents can be a great resource, but we

all have unique circumstances, so what applied to one family might not

apply to your family. The problem here is that we don't think to ask

what we don't already know, and therefore we end up with a problem

that can't be corrected after the fact.

[Guest guest]

Hi and Ellen,

Yes, let's get someone who can help people wade thru the new insurance law, and

in the meantime I'll post some of this thread in our files. Thanks to all who

have posted experiences with this, and good luck to us all.

Laurie

Re: Insurance coverage denial as a result of our new

Autism Law??

I just happened to be scanning through and thought I would comment. I

want others to benefit from my past experiences so that we all don't

have to suffer the consequences of " not knowing " something ahead of

time.

I have a 14 year old son who was born prematurely, and therefore, had

many chronic health issues in addition to his other diagnoses. As a

single parent, I had to do much research to advocate for him regarding

health insurance, the ADA guidelines for day care centers, etc. It

is always the fine print that is the problem. Even with the ADA, I

found that it " wrote you in " , and then " wrote you right back out " in

many instances, due to exclusions.

Although this may not be the case in your situation, this will be a

problem for many people and something that is not well known until it

happens to you. I have copied and pasted the important details from

the new law from a previous post.

The Autism Law Does Not Apply to:

o Self-insured, non-public employers.

o Self-insured health and welfare plans, such as union plans.

o Insurance policies or trusts issued in other states.

You may not realize it, but many companies are " self-insured " . They

insure themselves and then hire an insurance company to " administer "

their health and welfare benefits. Many large companies are self-

insured.

Self-insured companies are what I like to call " above the law. " They

don't have to abide by the Illinois insurance code, and that's a

fact. What we really need to advocate for is equal insurance for all.

Many families run into this problem when they are self-employed and

trying to purchase private healthcare coverage for their family. They

will find that their child with a " disability " is denied coverage

based solely on " the disability " . These insurance companies do not

have to accept everyone, and those that do will charge a hefty premium

that most cannot afford.

So this new " Autism Insurance Law " is really only a victory for a

small few. It will probably cause more people/families to lose their

healthcare coverage than it will actually help others.

IF YOUR EMPLOYER FALLS INTO THE ABOVE CATEGORIES, THE LAW WILL NOT

APPLY TO YOU!!!!!!

Also, keep HIPPA in mind. This is not just a " privacy act " , it stands

for " Health Insurance Privacy and Portability Act " . The portability

piece is important. If you go one single day without health insurance

coverage, your next health insurance provider can place " pre-existing

condition " restrictions on you. Make sure if you leave a job that you

take the COBRA health insurance if you can afford to do so. Do what

you can to make sure there is not a gap. Another fact that will help

people is the fact that Medicaid is health insurance coverage. So, if

you lose your private health insurance, but still are covered by

Medicaid, you have not had a gap in coverage.

I recommend that families try to keep their family member on their

private health care plan for as long as possible, because fewer and

fewer doctors (especially specialists) are accepting Medicaid.

Check to see if your employer is self-insured or if your health plan

is self-insured (your Human Resources Dept. should be able to provide

that information.) If they are, they are above the law. If they are

not, then the Illinois Insurance Code should apply. There is a law in

Illinois which would allow employees to continue to cover their adult

son/daughter on their health plan if the dependent has a disability.

You must request this in writing at least 60 days prior to the date

that their coverage would typically end (when they are no longer a

full-time student, or reach a certain age, etc.)

Another FYI, your son/daughter with a disability will become eligible

for Medicare (healthcare) 24 months after one of their parents A.

Retires B. Becomes disabled C. Is deceased. This means that they

may be eligible for Medicare before the age of 65 (or whatever the

age is now, seems to be a moving target).

My advice to everyone is that KNOWLEDGE IS POWER and to seek

professional assistance before any changes come up with health

insurance, assets, etc. Other parents can be a great resource, but we

all have unique circumstances, so what applied to one family might not

apply to your family. The problem here is that we don't think to ask

what we don't already know, and therefore we end up with a problem

that can't be corrected after the fact.

[Guest guest]

I will contact Gail Borgerd.

If anyone has another suggestion for a Guest Expert on insurance, please let us

know.

Ellen

Ellen Garber Bronfeld

egskb@...

Re: Insurance coverage denial as a result of our new

Autism Law??

I just happened to be scanning through and thought I would comment. I

want others to benefit from my past experiences so that we all don't

have to suffer the consequences of " not knowing " something ahead of

time.

I have a 14 year old son who was born prematurely, and therefore, had

many chronic health issues in addition to his other diagnoses. As a

single parent, I had to do much research to advocate for him regarding

health insurance, the ADA guidelines for day care centers, etc. It

is always the fine print that is the problem. Even with the ADA, I

found that it " wrote you in " , and then " wrote you right back out " in

many instances, due to exclusions.

Although this may not be the case in your situation, this will be a

problem for many people and something that is not well known until it

happens to you. I have copied and pasted the important details from

the new law from a previous post.

The Autism Law Does Not Apply to:

o Self-insured, non-public employers.

o Self-insured health and welfare plans, such as union plans.

o Insurance policies or trusts issued in other states.

You may not realize it, but many companies are " self-insured " . They

insure themselves and then hire an insurance company to " administer "

their health and welfare benefits. Many large companies are self-

insured.

Self-insured companies are what I like to call " above the law. " They

don't have to abide by the Illinois insurance code, and that's a

fact. What we really need to advocate for is equal insurance for all.

Many families run into this problem when they are self-employed and

trying to purchase private healthcare coverage for their family. They

will find that their child with a " disability " is denied coverage

based solely on " the disability " . These insurance companies do not

have to accept everyone, and those that do will charge a hefty premium

that most cannot afford.

So this new " Autism Insurance Law " is really only a victory for a

small few. It will probably cause more people/families to lose their

healthcare coverage than it will actually help others.

IF YOUR EMPLOYER FALLS INTO THE ABOVE CATEGORIES, THE LAW WILL NOT

APPLY TO YOU!!!!!!

Also, keep HIPPA in mind. This is not just a " privacy act " , it stands

for " Health Insurance Privacy and Portability Act " . The portability

piece is important. If you go one single day without health insurance

coverage, your next health insurance provider can place " pre-existing

condition " restrictions on you. Make sure if you leave a job that you

take the COBRA health insurance if you can afford to do so. Do what

you can to make sure there is not a gap. Another fact that will help

people is the fact that Medicaid is health insurance coverage. So, if

you lose your private health insurance, but still are covered by

Medicaid, you have not had a gap in coverage.

I recommend that families try to keep their family member on their

private health care plan for as long as possible, because fewer and

fewer doctors (especially specialists) are accepting Medicaid.

Check to see if your employer is self-insured or if your health plan

is self-insured (your Human Resources Dept. should be able to provide

that information.) If they are, they are above the law. If they are

not, then the Illinois Insurance Code should apply. There is a law in

Illinois which would allow employees to continue to cover their adult

son/daughter on their health plan if the dependent has a disability.

You must request this in writing at least 60 days prior to the date

that their coverage would typically end (when they are no longer a

full-time student, or reach a certain age, etc.)

Another FYI, your son/daughter with a disability will become eligible

for Medicare (healthcare) 24 months after one of their parents A.

Retires B. Becomes disabled C. Is deceased. This means that they

may be eligible for Medicare before the age of 65 (or whatever the

age is now, seems to be a moving target).

My advice to everyone is that KNOWLEDGE IS POWER and to seek

professional assistance before any changes come up with health

insurance, assets, etc. Other parents can be a great resource, but we

all have unique circumstances, so what applied to one family might not

apply to your family. The problem here is that we don't think to ask

what we don't already know, and therefore we end up with a problem

that can't be corrected after the fact.

[Guest guest]

Thank you, .

Finato

www.AngelSpeaks.com

www.wegrowdreams.org

From: <ng3@...>

Subject: Re: Insurance coverage denial as a result of our new

Autism Law??

IPADDUnite

Date: Saturday, December 27, 2008, 2:21 PM

I just happened to be scanning through and thought I would comment.

I

want others to benefit from my past experiences so that we all don't

have to suffer the consequences of " not knowing " something ahead of

time.

I have a 14 year old son who was born prematurely, and therefore, had

many chronic health issues in addition to his other diagnoses. As a

single parent, I had to do much research to advocate for him regarding

health insurance, the ADA guidelines for day care centers, etc. It

is always the fine print that is the problem. Even with the ADA, I

found that it " wrote you in " , and then " wrote you right back out " in

many instances, due to exclusions.

Although this may not be the case in your situation, this will be a

problem for many people and something that is not well known until it

happens to you. I have copied and pasted the important details from

the new law from a previous post.

The Autism Law Does Not Apply to:

o Self-insured, non-public employers.

o Self-insured health and welfare plans, such as union plans.

o Insurance policies or trusts issued in other states.

You may not realize it, but many companies are " self-insured " . They

insure themselves and then hire an insurance company to " administer "

their health and welfare benefits. Many large companies are self-

insured.

Self-insured companies are what I like to call " above the law. " They

don't have to abide by the Illinois insurance code, and that's a

fact. What we really need to advocate for is equal insurance for all.

Many families run into this problem when they are self-employed and

trying to purchase private healthcare coverage for their family. They

will find that their child with a " disability " is denied coverage

based solely on " the disability " . These insurance companies do not

have to accept everyone, and those that do will charge a hefty premium

that most cannot afford.

So this new " Autism Insurance Law " is really only a victory for a

small few. It will probably cause more people/families to lose their

healthcare coverage than it will actually help others.

IF YOUR EMPLOYER FALLS INTO THE ABOVE CATEGORIES, THE LAW WILL NOT

APPLY TO YOU!!!!!!

Also, keep HIPPA in mind. This is not just a " privacy act " , it stands

for " Health Insurance Privacy and Portability Act " . The portability

piece is important. If you go one single day without health insurance

coverage, your next health insurance provider can place " pre-existing

condition " restrictions on you. Make sure if you leave a job that you

take the COBRA health insurance if you can afford to do so. Do what

you can to make sure there is not a gap. Another fact that will help

people is the fact that Medicaid is health insurance coverage. So, if

you lose your private health insurance, but still are covered by

Medicaid, you have not had a gap in coverage.

I recommend that families try to keep their family member on their

private health care plan for as long as possible, because fewer and

fewer doctors (especially specialists) are accepting Medicaid.

Check to see if your employer is self-insured or if your health plan

is self-insured (your Human Resources Dept. should be able to provide

that information. ) If they are, they are above the law. If they are

not, then the Illinois Insurance Code should apply. There is a law in

Illinois which would allow employees to continue to cover their adult

son/daughter on their health plan if the dependent has a disability.

You must request this in writing at least 60 days prior to the date

that their coverage would typically end (when they are no longer a

full-time student, or reach a certain age, etc.)

Another FYI, your son/daughter with a disability will become eligible

for Medicare (healthcare) 24 months after one of their parents A.

Retires B. Becomes disabled C. Is deceased. This means that they

may be eligible for Medicare before the age of 65 (or whatever the

age is now, seems to be a moving target).

My advice to everyone is that KNOWLEDGE IS POWER and to seek

professional assistance before any changes come up with health

insurance, assets, etc. Other parents can be a great resource, but we

all have unique circumstances, so what applied to one family might not

apply to your family. The problem here is that we don't think to ask

what we don't already know, and therefore we end up with a problem

that can't be corrected after the fact.

[Guest guest]

,

Thanks so much for your reply, and for sharing your history. I agree with you,

if you happen to fit into the small category that this law covers, great for you

and your family. However, if insurance companies can just " deny " coverage for

someone diagnosed with Autism, they will never be subject to the new law at all;

there are a whole lot of people out there, and probably in increasing numbers

over time, that will never ever benefit from this law at all.

-------------- Original message --------------

From: <ng3@...>

I just happened to be scanning through and thought I would comment. I

want others to benefit from my past experiences so that we all don't

have to suffer the consequences of " not knowing " something ahead of

time.

I have a 14 year old son who was born prematurely, and therefore, had

many chronic health issues in addition to his other diagnoses. As a

single parent, I had to do much research to advocate for him regarding

health insurance, the ADA guidelines for day care centers, etc. It

is always the fine print that is the problem. Even with the ADA, I

found that it " wrote you in " , and then " wrote you right back out " in

many instances, due to exclusions.

Although this may not be the case in your situation, this will be a

problem for many people and something that is not well known until it

happens to you. I have copied and pasted the important details from

the new law from a previous post.

The Autism Law Does Not Apply to:

o Self-insured, non-public employers.

o Self-insured health and welfare plans, such as union plans.

o Insurance policies or trusts issued in other states.

You may not realize it, but many companies are " self-insured " . They

insure themselves and then hire an insurance company to " administer "

their health and welfare benefits. Many large companies are self-

insured.

Self-insured companies are what I like to call " above the law. " They

don't have to abide by the Illinois insurance code, and that's a

fact. What we really need to advocate for is equal insurance for all.

Many families run into this problem when they are self-employed and

trying to purchase private healthcare coverage for their family. They

will find that their child with a " disability " is denied coverage

based solely on " the disability " . These insurance companies do not

have to accept everyone, and those that do will charge a hefty premium

that most cannot afford.

So this new " Autism Insurance Law " is really only a victory for a

small few. It will probably cause more people/families to lose their

healthcare coverage than it will actually help others.

IF YOUR EMPLOYER FALLS INTO THE ABOVE CATEGORIES, THE LAW WILL NOT

APPLY TO YOU!!!!!!

Also, keep HIPPA in mind. This is not just a " privacy act " , it stands

for " Health Insurance Privacy and Portability Act " . The portability

piece is important. If you go one single day without health insurance

coverage, your next health insurance provider can place " pre-existing

condition " restrictions on you. Make sure if you leave a job that you

take the COBRA health insurance if you can afford to do so. Do what

you can to make sure there is not a gap. Another fact that will help

people is the fact that Medicaid is health insurance coverage. So, if

you lose your private health insurance, but still are covered by

Medicaid, you have not had a gap in coverage.

I recommend that families try to keep their family member on their

private health care plan for as long as possible, because fewer and

fewer doctors (especially specialists) are accepting Medicaid.

Check to see if your employer is self-insured or if your health plan

is self-insured (your Human Resources Dept. should be able to provide

that information.) If they are, they are above the law. If they are

not, then the Illinois Insurance Code should apply. There is a law in

Illinois which would allow employees to continue to cover their adult

son/daughter on their health plan if the dependent has a disability.

You must request this in writing at least 60 days prior to the date

that their coverage would typically end (when they are no longer a

full-time student, or reach a certain age, etc.)

Another FYI, your son/daughter with a disability will become eligible

for Medicare (healthcare) 24 months after one of their parents A.

Retires B. Becomes disabled C. Is deceased. This means that they

may be eligible for Medicare before the age of 65 (or whatever the

age is now, seems to be a moving target).

My advice to everyone is that KNOWLEDGE IS POWER and to seek

professional assistance before any changes come up with health

insurance, assets, etc. Other parents can be a great resource, but we

all have unique circumstances, so what applied to one family might not

apply to your family. The problem here is that we don't think to ask

what we don't already know, and therefore we end up with a problem

that can't be corrected after the fact.

[Guest guest]

, insurance companies can deny coverage to anyone with any preexisting or

they can put a rider on that condition meaning they won't cover that condition

but all other medical issues are covered.

Finato

www.AngelSpeaks.com

www.wegrowdreams.org

From: crzymomf3@... <crzymomf3@...>

Subject: Re: Re: Insurance coverage denial as a result of our new

Autism Law??

IPADDUnite

Date: Monday, December 29, 2008, 4:07 AM

,

Thanks so much for your reply, and for sharing your history. I agree with you,

if you happen to fit into the small category that this law covers, great for you

and your family. However, if insurance companies can just " deny " coverage for

someone diagnosed with Autism, they will never be subject to the new law at all;

there are a whole lot of people out there, and probably in increasing numbers

over time, that will never ever benefit from this law at all.

------------ -- Original message ------------ --

From: <ng3sbcglobal (DOT) net>

I just happened to be scanning through and thought I would comment. I

want others to benefit from my past experiences so that we all don't

have to suffer the consequences of " not knowing " something ahead of

time.

I have a 14 year old son who was born prematurely, and therefore, had

many chronic health issues in addition to his other diagnoses. As a

single parent, I had to do much research to advocate for him regarding

health insurance, the ADA guidelines for day care centers, etc. It

is always the fine print that is the problem. Even with the ADA, I

found that it " wrote you in " , and then " wrote you right back out " in

many instances, due to exclusions.

Although this may not be the case in your situation, this will be a

problem for many people and something that is not well known until it

happens to you. I have copied and pasted the important details from

the new law from a previous post.

The Autism Law Does Not Apply to:

o Self-insured, non-public employers.

o Self-insured health and welfare plans, such as union plans.

o Insurance policies or trusts issued in other states.

You may not realize it, but many companies are " self-insured " . They

insure themselves and then hire an insurance company to " administer "

their health and welfare benefits. Many large companies are self-

insured.

Self-insured companies are what I like to call " above the law. " They

don't have to abide by the Illinois insurance code, and that's a

fact. What we really need to advocate for is equal insurance for all.

Many families run into this problem when they are self-employed and

trying to purchase private healthcare coverage for their family. They

will find that their child with a " disability " is denied coverage

based solely on " the disability " . These insurance companies do not

have to accept everyone, and those that do will charge a hefty premium

that most cannot afford.

So this new " Autism Insurance Law " is really only a victory for a

small few. It will probably cause more people/families to lose their

healthcare coverage than it will actually help others.

IF YOUR EMPLOYER FALLS INTO THE ABOVE CATEGORIES, THE LAW WILL NOT

APPLY TO YOU!!!!!!

Also, keep HIPPA in mind. This is not just a " privacy act " , it stands

for " Health Insurance Privacy and Portability Act " . The portability

piece is important. If you go one single day without health insurance

coverage, your next health insurance provider can place " pre-existing

condition " restrictions on you. Make sure if you leave a job that you

take the COBRA health insurance if you can afford to do so. Do what

you can to make sure there is not a gap. Another fact that will help

people is the fact that Medicaid is health insurance coverage. So, if

you lose your private health insurance, but still are covered by

Medicaid, you have not had a gap in coverage.

I recommend that families try to keep their family member on their

private health care plan for as long as possible, because fewer and

fewer doctors (especially specialists) are accepting Medicaid.

Check to see if your employer is self-insured or if your health plan

is self-insured (your Human Resources Dept. should be able to provide

that information. ) If they are, they are above the law. If they are

not, then the Illinois Insurance Code should apply. There is a law in

Illinois which would allow employees to continue to cover their adult

son/daughter on their health plan if the dependent has a disability.

You must request this in writing at least 60 days prior to the date

that their coverage would typically end (when they are no longer a

full-time student, or reach a certain age, etc.)

Another FYI, your son/daughter with a disability will become eligible

for Medicare (healthcare) 24 months after one of their parents A.

Retires B. Becomes disabled C. Is deceased. This means that they

may be eligible for Medicare before the age of 65 (or whatever the

age is now, seems to be a moving target).

My advice to everyone is that KNOWLEDGE IS POWER and to seek

professional assistance before any changes come up with health

insurance, assets, etc. Other parents can be a great resource, but we

all have unique circumstances, so what applied to one family might not

apply to your family. The problem here is that we don't think to ask

what we don't already know, and therefore we end up with a problem

that can't be corrected after the fact.

[Guest guest]

Thanks again, for some great information!

Ellen

Ellen Garber Bronfeld

egskb@...

Re: Insurance coverage denial as a result of our new

Autism Law??

Medicaid spend down would not be a gap, provided you meet the spend

down every single month. If you don't meet the monthly spend down,

you do not have Medicaid for that month. If you do not have any other

health insurance, then yes, you have a gap in coverage.

There's no reason anymore for anyone to not meet their Medicaid spend

down because their is now the Medicaid Buy-In program. You can pay

the spend down amount and " buy in " to Medicaid coverage. Call your

Medicaid case worker or go in to your local office to request an

application for the buy in program.

There is also the Health Benefits for Workers with Disabilities (HBWD)

program for those that are working and paying into FICA. HBWD allows

you a much higher gainful earnings limit and also a much higher amount

of assets. The web link for HBWD is: http://www.hbwdillinois.com/

I hope this helps you and others,