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

[Guest guest]

Hello all. See the attached fact sheet about the new autism law. This was

forwarded to me by Pete DiCiani the author of the bill.

Teri

In a message dated 12/26/2008 4:55:41 P.M. Central Standard Time,

cporter8404@... writes:

I don't know what effect the new law will have on coverage for people with

autism, but I do know from personal experience that a diagnosis of autism has

been an automatic denial for coverage for at least 8 years (that's when my son

was denied.) This was through BCBS.

He's has had ICHIP since that point in time and we have no complaints.

Chantelle

Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <_IPADDUnite@groIPADDUn_

(mailto:IPADDUnite ) >, " Autism chicago "

<_AutismNews@groAutismN_

(mailto:AutismNews ) >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my sons

because of their Autism, I am wondering what good the law will do us all if

insurance companies begin/increase their denials of health insurance coverage

for families affected with Autism. Isn't this just a way for them to get out of

complying with the new law. And this denial comes from a very reputable

Illinois insurance company (BCBS of Illinois).

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

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[Guest guest]

It doesn't look like the attachment went through. Here is the text version

of the fact sheet:

Illinois Insurance Facts

Illinois Department of Financial and Professional Regulation

Division of Insurance

Insurance Coverage for Autism

December 2008

For children diagnosed with autism, early intervention and continued

treatment is critical.

Effective December 12, 2008, all individual and group health insurance

policies and HMO contracts

must abide by the provisions of Public Act 95-1005 (215 ILCS 356z.14). This

new Illinois law

provides coverage for the diagnosis and treatment of autism spectrum

disorders for children under

21, establishing an annual benefit of $36,000 for services provided pursuant

to this Act. Here are

the basic facts about the new law.

Who Must Offer Autism Coverage?

All individual and group health insurance policies and HMO contracts (and

voluntary health service

organization contracts) must abide by the new law. Health coverage provided

to state, county, and

municipal employees (and employees subject to the Schools Code (105 ILCS

5/1-1 et seq.)) must

also provide the autism benefits.

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.

NOTE: For HMOs, the law does apply to contracts written outside of Illinois

if the HMO member is a

resident of Illinois and the HMO has established a provider network in

Illinois. To determine if your

HMO coverage is required to provide treatment for autism, contact the HMO or

check your

certificate of coverage.

The law does not change the autism coverage provided by public health care

programs such as

FamilyCare and All Kids. Contact the specific program for more information

about its autism

coverage.

Who is Covered?

Children under the age of 21 who have health coverage through an individual

or group policy, as

described above, will receive coverage for the diagnosis and treatment of

autism spectrum

disorders.

What is Covered?

The new law requires coverage for the diagnosis of autism spectrum

disorders. For individuals

diagnosed with an autism spectrum disorder, the new law also requires

coverage for the following

treatment:

o Psychiatric care;

o Psychological care;

o Habilitative or rehabilitative care (counseling and treatment programs

intended to develop,

maintain, and restore the functioning of an individual); and

o Therapeutic care, including behavioral, speech, occupational, and physical

therapies

addressing the following areas:

o Self-care and feeding

o Pragmatic, receptive, and expressive language

o Cognitive functioning

o Applied behavioral analysis, intervention, and modification

o Motor planning

o Sensory processing

Insurance companies may not impose dollar limits, deductibles or copayments

for the diagnosis or

treatment of autism which differ from the dollar limits, deductibles or

copayments established for

physical illness.

All services covered by this new law must be prescribed by a physician.

However, some of the

services may be delivered by certified or licensed professionals who are not

physicians (e.g.,

speech therapists, physical therapists, and occupational therapists).

Insurance companies are

required to cover medically necessary care provided by these professionals.

What are the Limits of Coverage Under the New Law?

This law requires insurance companies to provide coverage for the diagnosis

and treatment of

autism up to an annual limit of $36,000. An insurance company may provide

coverage beyond this

limit, but is not required to do so by this law.

• Insurance companies are prohibited from limiting the number of visits to a

physician or other

service provider.

• Treatments for conditions not diagnosed as autism will not apply to the

$36,000 annual limit.

The Illinois Serious Mental Illness Mandate (215 ILCS 370c) requires group

insurance policies

covering more than 50 employees and all group HMO contracts to cover certain

autism treatments.

Benefits provided by this new autism law are in addition to benefits

provided by the Serious Mental

Illness Mandate. The Serious Mental Illness Mandate benefit limits are not

altered by Public Act 95-

1005. For more information about the Serious Mental Illness Mandate, please

see the Division’s

fact sheet on Mental Health Coverage at

_http://www.idfpr.com/doi/HealthInsurance/mental_hlth.asp_

(http://www.idfpr.com/doi/HealthInsurance/mental_hlth.asp) .

Insurance companies may not categorize benefits historically covered under

the Serious Mental

Illness Mandate as benefits now covered under this new law.

Can Insurers Deny Claims Based on Medical Necessity?

Like coverage for other conditions, coverage for the treatment of autism is

subject to insurance

company determinations of medical necessity. An insurance company may deny

coverage for a

certain treatment if the treatment is not medically necessary or does not

result in improved clinical

status.

A treatment must be considered medically necessary if it is reasonably

expected to:

o Prevent the onset of an illness, condition, injury, disease or disability;

o Reduce or ameliorate the physical, mental or developmental effects of an

illness, condition,

injury, disease or disability; or

o Help an individual achieve or maintain maximum functional activity in

performing daily

activities.

If an insurance company denies a claim based on an adverse determination of

medical necessity,

you may appeal the company’s decision. The company’s decision must be based

on a

determination made by a physician with expertise in the most current and

effective treatments for

autism spectrum disorders.

Appeal procedures and applicable state laws differ for HMOs and insurance

companies. For more

information, please see the Division’s fact sheet on Medical Necessity

(_http://www.idfpr.com/DOI/HealthInsurance/Medical_Necessity.asp_

(http://www.idfpr.com/DOI/HealthInsurance/Medical_Necessity.asp) ).

When Will Coverage Under the Law Take Effect?

The law became effective December 12, 2008. Any policy issued, delivered or

renewed after this

date must include autism coverage required by the law.

If you are covered by a group health insurance policy (i.e., through your

employer) issued before

December 12, 2008, you may have to wait until the policy’s renewal date

before your child is eligible

for autism coverage under this law. Check with your group or your insurer to

find your policy’s

renewal date.

If you are covered by an individual health insurance policy issued before

December 12, 2008, you

may have to wait until the policy’s renewal date or anniversary date before

your child is eligible for

autism coverage under this law. Check with your insurer to find your policy’

s renewal or anniversary

date.

For More Information

Call the Division of Insurance Consumer Services Section at (312) 814-2427

or

our Office of Consumer Health Insurance toll free at (877) 527-9431

or visit us on our website at _www.ins.state.il.us_

(http://www.ins.state.il.us)

In a message dated 12/26/2008 4:55:41 P.M. Central Standard Time,

cporter8404@... writes:

I don't know what effect the new law will have on coverage for people with

autism, but I do know from personal experience that a diagnosis of autism has

been an automatic denial for coverage for at least 8 years (that's when my son

was denied.) This was through BCBS.

He's has had ICHIP since that point in time and we have no complaints.

Chantelle

Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <_IPADDUnite@groIPADDUn_

(mailto:IPADDUnite ) >, " Autism chicago "

<_AutismNews@groAutismN_

(mailto:AutismNews ) >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my sons

because of their Autism, I am wondering what good the law will do us all if

insurance companies begin/increase their denials of health insurance coverage

for families affected with Autism. Isn't this just a way for them to get out of

complying with the new law. And this denial comes from a very reputable

Illinois insurance company (BCBS of Illinois).

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

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[Guest guest]

Hi Gail,

I thought the same thing, but this was what BCBS said,

" The underwriting of your family's application is complete. Upon careful

review, we determined that **** and **** are not eligible for coverage. Our

decision was based on our current underwriting guidelines and ***'s and ***'s

medical history, which includes: autism spectrum disorder, as indicated on the

application. "

This was the result of a private application, which I thought the law covered.

We obviously disclosed their diagnosis on the application, in the spirit of full

disclosure. Now, they are clearly denying my sons' coverage as a result of

their autism diagnosis, nothing more - they have no other medical history to

speak of, and they only go to the doctor for their annual check-ups - these are

very, very healthy kids!!

Needless to say, we were shocked, not just at the denial, but at the denial for

medical just because they are diagnosed with Autism - we don't even submit any

therapies for reimbursement (no OT, no Speech, no allergist, no ABA, no

psychologist, etc.). Generally speaking, these two Spectrum boys are pretty

cheap to cover.

I can't help but wonder if this is just because of the new law, and if this is

just the beginning of a bigger problem that we may all have in the future.

--------- Possible increase in insurance coverage denial as a result

of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite >, " Autism chicago "

<AutismNews >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new Illinois

Autism Law?

I have always expected a larger premium for families with a child with Autism,

but having just received a " denial of health care coverage " for my sons because

of their Autism, I am wondering what good the law will do us all if insurance

companies begin/increase their denials of health insurance coverage for families

affected with Autism. Isn't this just a way for them to get out of complying

with the new law. And this denial comes from a very reputable Illinois insurance

company (BCBS of Illinois).

[Guest guest]

Did you submit your application prior to the law being signed, December 12?

If so, resubmit it. If not, please call me next week-there may be some

things we can do.

M. Kennedy

cmk@...

Kennedy Pierson & Strachan LLP

in Chicago:

300 S. Wacker Drive

Suite 3400

Chicago, Illinois 60606-6708

312-829-7000 Phone

in Lake Forest:

668 N. Western Avenue

Lake Forest, Illinois 60045-5317

847-295-0300 Phone

847-295-0344 Fax

www.kennedypierson.com

NOTICE: This email message and all attachments are intended solely for the

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From: IPADDUnite [mailto:IPADDUnite ] On

Behalf Of crzymomf3@...

Sent: Friday, December 26, 2008 3:20 PM

IPADDUnite

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

Autism Law??

Hi Gail,

I thought the same thing, but this was what BCBS said,

" The underwriting of your family's application is complete. Upon careful

review, we determined that **** and **** are not eligible for coverage. Our

decision was based on our current underwriting guidelines and ***'s and

***'s medical history, which includes: autism spectrum disorder, as

indicated on the application. "

This was the result of a private application, which I thought the law

covered. We obviously disclosed their diagnosis on the application, in the

spirit of full disclosure. Now, they are clearly denying my sons' coverage

as a result of their autism diagnosis, nothing more - they have no other

medical history to speak of, and they only go to the doctor for their annual

check-ups - these are very, very healthy kids!!

Needless to say, we were shocked, not just at the denial, but at the denial

for medical just because they are diagnosed with Autism - we don't even

submit any therapies for reimbursement (no OT, no Speech, no allergist, no

ABA, no psychologist, etc.). Generally speaking, these two Spectrum boys are

pretty cheap to cover.

I can't help but wonder if this is just because of the new law, and if this

is just the beginning of a bigger problem that we may all have in the

future.

--------- Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite

<mailto:IPADDUnite%40> >, " Autism chicago "

<AutismNews <mailto:AutismNews%40> >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my

sons because of their Autism, I am wondering what good the law will do us

all if insurance companies begin/increase their denials of health insurance

coverage for families affected with Autism. Isn't this just a way for them

to get out of complying with the new law. And this denial comes from a very

reputable Illinois insurance company (BCBS of Illinois).

[Guest guest]

, as soon as I started applying for private coverage, just by indicating

autism, Angel was denied.  This was before she started being on meds.  Insurance

companies WILL automatically deny coverage to individuals based on preexisting,

even if that person is currently healthy.

Let's face it, insurance companies are in the business to make money, people

with preexisting are at risk for higher medical bills.  Now, Angel's meds are

like $500 a month, plus periodic visits to the psychiatrist to monitor them and

bloodwork.

Finato

www.AngelSpeaks.com

www.wegrowdreams.org

From: crzymomf3comcast (DOT) net <crzymomf3comcast (DOT) net>

Subject: Possible increase in insurance coverage denial as a result

of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite@gro ups.com>, " Autism chicago "

<AutismNews@gro ups.com>

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new Illinois

Autism Law?

I have always expected a larger premium for families with a child with Autism,

but having just received a " denial of health care coverage " for my sons because

of their Autism, I am wondering what good the law will do us all if insurance

companies begin/increase their denials of health insurance coverage for families

affected with Autism. Isn't this just a way for them to get out of complying

with the new law. And this denial comes from a very reputable Illinois insurance

company (BCBS of Illinois).

[Guest guest]

I don't know what effect the new law will have on coverage for people with

autism, but I do know from personal experience that a diagnosis of autism has

been an automatic denial for coverage for at least 8 years (that's when my son

was denied.) This was through BCBS.

He's has had ICHIP since that point in time and we have no complaints.

Chantelle

Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite >, " Autism chicago "

<AutismNews >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new Illinois

Autism Law?

I have always expected a larger premium for families with a child with Autism,

but having just received a " denial of health care coverage " for my sons because

of their Autism, I am wondering what good the law will do us all if insurance

companies begin/increase their denials of health insurance coverage for families

affected with Autism. Isn't this just a way for them to get out of complying

with the new law. And this denial comes from a very reputable Illinois insurance

company (BCBS of Illinois).

[Guest guest]

when does the new law start?? I remember when they started covering birth

control pills, it didn't go into effect until the beginning of a calendar year.?

If that's not the case, this is just ridiculous!

H.

Re: Insurance coverage denial as a result of our new

Autism Law??

Hi Gail,

I thought the same thing, but this was what BCBS said,

" The underwriting of your family's application is complete. Upon careful

review, we determined that **** and **** are not eligible for coverage. Our

decision was based on our current underwriting guidelines and ***'s and ***'s

medical history, which includes: autism spectrum disorder, as indicated on the

application. "

This was the result of a private application, which I thought the law covered.

We obviously disclosed their diagnosis on the application, in the spirit of full

disclosure. Now, they are clearly denying my sons' coverage as a result of

their autism diagnosis, nothing more - they have no other medical history to

speak of, and they only go to the doctor for their annual check-ups - these are

very, very healthy kids!!

Needless to say, we were shocked, not just at the denial, but at the denial for

medical just because they are diagnosed with Autism - we don't even submit any

therapies for reimbursement (no OT, no Speech, no allergist, no ABA, no

psychologist, etc.). Generally speaking, these two Spectrum boys are pretty

cheap to cover.

I can't help but wonder if this is just because of the new law, and if this is

just the beginning of a bigger problem that we may all have in the future.

--------- Possible

increase in insurance coverage denial as a result

of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite >, " Autism chicago "

<AutismNews >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new Illinois

Autism Law?

I have always expected a larger premium for families with a child with Autism,

but having just received a " denial of health care coverage " for my sons because

of their Autism, I am wondering what good the law will do us all if insurance

companies begin/increase their denials of health insurance coverage for families

affected with Autism. Isn't this just a way for them to get out of complying

with the new law. And this denial comes from a very reputable Illinois insurance

company (BCBS of Illinois).

[Guest guest]

Attachments do not work on this site, Teri.

Feel free to send the information to me and I will cut and paste it or put it in

our files section...

All this insurance discussion makes me VERY glad we did have decent coverage for

Noah, twenty years ago and up until he went on Medicaid. It is discouraging to

hear that insurance companies are finding a way around covering our children. I

am guessing that a good fight, proper insurance coding and tenacity would go a

long way in changing that.

I do not know what she charges, but there is a woman by the name of Gail Borgerd

who works with families who are denied coverage or who are having other issues

with their insurance companies. Her email address is mediclaim@...

She is also a parent of a young adult son with a disability, so she " gets it. "

Ellen

Ellen Garber Bronfeld

egskb@...

Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <_IPADDUnite@groIPADDUn_

(mailto:IPADDUnite ) >, " Autism chicago "

<_AutismNews@groAutismN_

(mailto:AutismNews ) >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my

sons

because of their Autism, I am wondering what good the law will do us all if

insurance companies begin/increase their denials of health insurance coverage

for families affected with Autism. Isn't this just a way for them to get out

of

complying with the new law. And this denial comes from a very reputable

Illinois insurance company (BCBS of Illinois).

[Guest guest]

My experience has been the same.

Finato

www.AngelSpeaks.com

www.wegrowdreams.org

From: crzymomf3comcast (DOT) net <crzymomf3comcast (DOT) net>

Subject: Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite@gro ups.com>, " Autism

chicago " <AutismNews@gro ups.com>

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new Illinois

Autism Law?

I have always expected a larger premium for families with a child with Autism,

but having just received a " denial of health care coverage " for my sons because

of their Autism, I am wondering what good the law will do us all if insurance

companies begin/increase their denials of health insurance coverage for families

affected with Autism. Isn't this just a way for them to get out of complying

with the new law. And this denial comes from a very reputable Illinois insurance

company (BCBS of Illinois).

[Guest guest]

IOW, smaller companies are exempt, unions are exempt, individual health policies

are exempt, etc,  so we can see an increase of children being denied insurance

coverage because of a diagnosis of autism.

So, who does it help?  Those working for larger companies, until the larger

companies find that health insurance coverage is getting out of control and

compensate by making their employees pay a much larger share.

Finato

www.AngelSpeaks.com

www.wegrowdreams.org

From: _crzymomf3comcast (DOT) crz_ (mailto:crzymomf3comcast (DOT) net)

<_crzymomf3comcast (DOT) crz_ (mailto:crzymomf3comcast (DOT) net) >

Subject: Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <_IPADDUnite@ groIPADDUn_

(mailto:IPADDUnite@gro ups.com) >, " Autism chicago " <_AutismNews@

groAutismN_

(mailto:AutismNews@gro ups.com) >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my sons

because of their Autism, I am wondering what good the law will do us all if

insurance companies begin/increase their denials of health insurance coverage

for families affected with Autism. Isn't this just a way for them to get out of

complying with the new law. And this denial comes from a very reputable

Illinois insurance company (BCBS of Illinois).

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

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Gmail, and Mail. Try it now.

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m00000025)

[Guest guest]

Based on this, I'd appeal.  The questioner said she and her family applied for

BCBS in a private (individual, not employer) policy.  The " self-insured " means a

company is doing the insurance, although the company may have a big-name

insurance company doing the administrating.

Unless other posts here have a better plan, I'd call BCBS and ask them how this

new law affects what they mailed.  If they say there needs to be a reapplication

to add the boys, then do it. 

Yes, it was right to give the boys' dx.  Without giving it, if there had been

any claims related to autism later, the insurance company could have denied the

claim, kicked the kid(s) out of the plan, and gotten the parents fined for

fraud.

However, it is also appropriate to include a written statement on each boy,

saying when the dx was made, and that there have been no special therapies

pursued or unusual or atypical medical expenses incurred for either boy

since....and give the age or year.  State clearly that the therapies provided by

the public schools are adequate for their needs.   Write  " they have only had

the following insurable care in the past 3 years " and list every MD visit and

eye exam, including dates. 

This may be overkill, because I think you applied and they responded before the

law took effect, and that's why I say call and ask first.

If for some reason the kind of plan is one of those listed in the law as being

exempt, then I'd consider making changes to get them coverage.  That might mean

changing jobs.

-Gail

From: _crzymomf3comcast (DOT) crz_ (mailto:crzymomf3comcast (DOT) net)

<_crzymomf3comcast (DOT) crz_ (mailto:crzymomf3comcast (DOT) net) >

Subject: Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <_IPADDUnite@ groIPADDUn_

(mailto:IPADDUnite@gro ups.com) >, " Autism chicago " <_AutismNews@

groAutismN_

(mailto:AutismNews@gro ups.com) >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my sons

because of their Autism, I am wondering what good the law will do us all if

insurance companies begin/increase their denials of health insurance coverage

for families affected with Autism. Isn't this just a way for them to get out of

complying with the new law. And this denial comes from a very reputable

Illinois insurance company (BCBS of Illinois).

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

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[Guest guest]

The law took effect upon becoming law: December 12, 2008.

M. Kennedy

cmk@...

Kennedy Pierson & Strachan LLP

in Chicago:

300 S. Wacker Drive

Suite 3400

Chicago, Illinois 60606-6708

312-829-7000 Phone

in Lake Forest:

668 N. Western Avenue

Lake Forest, Illinois 60045-5317

847-295-0300 Phone

847-295-0344 Fax

www.kennedypierson.com

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From: IPADDUnite [mailto:IPADDUnite ] On

Behalf Of sunshinebeaches3@...

Sent: Friday, December 26, 2008 5:51 PM

IPADDUnite

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

Autism Law??

when does the new law start?? I remember when they started covering

birth control pills, it didn't go into effect until the beginning of a

calendar year.? If that's not the case, this is just ridiculous!

H.

Re: Insurance coverage denial as a result of our new

Autism Law??

Hi Gail,

I thought the same thing, but this was what BCBS said,

" The underwriting of your family's application is complete. Upon careful

review, we determined that **** and **** are not eligible for coverage. Our

decision was based on our current underwriting guidelines and ***'s and

***'s

medical history, which includes: autism spectrum disorder, as indicated on

the

application. "

This was the result of a private application, which I thought the law

covered.

We obviously disclosed their diagnosis on the application, in the spirit of

full

disclosure. Now, they are clearly denying my sons' coverage as a result of

their autism diagnosis, nothing more - they have no other medical history to

speak of, and they only go to the doctor for their annual check-ups - these

are

very, very healthy kids!!

Needless to say, we were shocked, not just at the denial, but at the denial

for

medical just because they are diagnosed with Autism - we don't even submit

any

therapies for reimbursement (no OT, no Speech, no allergist, no ABA, no

psychologist, etc.). Generally speaking, these two Spectrum boys are pretty

cheap to cover.

I can't help but wonder if this is just because of the new law, and if this

is

just the beginning of a bigger problem that we may all have in the future.

--------- Possible

increase in insurance coverage denial as a result

of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite

<mailto:IPADDUnite%40> >, " Autism chicago "

<AutismNews <mailto:AutismNews%40> >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois

Autism Law?

I have always expected a larger premium for families with a child with

Autism,

but having just received a " denial of health care coverage " for my sons

because

of their Autism, I am wondering what good the law will do us all if

insurance

companies begin/increase their denials of health insurance coverage for

families

affected with Autism. Isn't this just a way for them to get out of complying

with the new law. And this denial comes from a very reputable Illinois

insurance

company (BCBS of Illinois).

[Guest guest]

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 that offer individual plans make it a point to automatically

turned down those with autism.  They won't tell you that if you inquire ahead of

time, they always respond that the application has to go to the underwriters

first.   I've even had one insurance broker honest enough to tell me that (he

specialized in the insurance policies offered through the schools.  She can

appeal the ruling, but BC/BS bases their decision on what the future medical

costs may be.  I know someone with asthma who told me he always gets turned

down.  It's a terrible plight that individuals with preexisting conditions have

to endure.  For years, I've applied for Angel and got turned down each time. 

BC/BS even has a policy just for children that we applied for and got turned

down.

Finato

www.AngelSpeaks.com

www.wegrowdreams.org

From: _crzymomf3comcast (DOT) crz_ (mailto:crzymomf3comcast (DOT) net)

<_crzymomf3comcast (DOT) crz_ (mailto:crzymomf3comcast (DOT) net) >

Subject: Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <_IPADDUnite@ groIPADDUn_

(mailto:IPADDUnite@gro ups.com) >, " Autism chicago "

<_AutismNews@ groAutismN_

(mailto:AutismNews@gro ups.com) >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage "

for my sons

because of their Autism, I am wondering what good the law will do us all if

insurance companies begin/increase their denials of health insurance coverage

for families affected with Autism. Isn't this just a way for them to get

out of

complying with the new law. And this denial comes from a very reputable

Illinois insurance company (BCBS of Illinois).

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

************ **One site keeps you connected to all your email: AOL Mail,

Gmail, and Mail. Try it now.

(http://www.aol. com/?optin= new-dp & icid= aolcom40vanity &

ncid=emlcntaolco m00000025)

[Guest guest]

Is Medicaid Spend Down a gap?

>

> 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]

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,

[Guest guest]

Hey

We submitted after, and have just been denied, today, by Humana. Also, on the

phone today, we found out that CIGNA doesn't even write individual policies

anymore in Illinois. I am not sure that there is anything that can be done.

While everyone was fighting so hard to get this law passed, the insurance

companies were plotting on how they were not going to allow themselves to be

subject to it.

--------- Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite

<mailto:IPADDUnite%40> >, " Autism chicago "

<AutismNews <mailto:AutismNews%40> >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my

sons because of their Autism, I am wondering what good the law will do us

all if insurance companies begin/increase their denials of health insurance

coverage for families affected with Autism. Isn't this just a way for them

to get out of complying with the new law. And this denial comes from a very

reputable Illinois insurance company (BCBS of Illinois).

[Guest guest]

This is all just too sad and frustrating.

I am negotiating with an expert on insurance issues for an Ask the Expert

segment on IPADDU. Unfortunately, she is definitely not available immediately

and it may be spring before she can answer our questions. In the meantime, she

has assured me that what she will be doing prior to joining us to answer

questions is becoming a real expert on the new law and how it will work (or

not), here in Illinois.

If anyone can come up with strategies to make the law work to the maximum extent

possible, I believe she would be the one. She is very creative and she is

relentless in working with insurance companies on behalf of her clients.

Ellen

Ellen Garber Bronfeld

egskb@...

Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite

<mailto:IPADDUnite%40> >, " Autism chicago "

<AutismNews <mailto:AutismNews%40> >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my

sons because of their Autism, I am wondering what good the law will do us

all if insurance companies begin/increase their denials of health insurance

coverage for families affected with Autism. Isn't this just a way for them

to get out of complying with the new law. And this denial comes from a very

reputable Illinois insurance company (BCBS of Illinois).

[Guest guest]

Thanks, Ellen.

I think that we all could use some expert advice in this area. This experience

has taken the expression " the devil is in the details " to a whole new level for

us!!

--------- Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite

<mailto:IPADDUnite%40> >, " Autism chicago "

<AutismNews <mailto:AutismNews%40> >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my

sons because of their Autism, I am wondering what good the law will do us

all if insurance companies begin/increase their denials of health insurance

coverage for families affected with Autism. Isn't this just a way for them

to get out of complying with the new law. And this denial comes from a very

reputable Illinois insurance company (BCBS of Illinois).

[Guest guest]

Unfortunately, Gail Borgerd is not available until May, but she is an expert on

insurance issues...she helps people with insurance claims and she has done

battle with the insurance industry for quite some time.

In the meantime, by then, some families will have filed claims and we will see

how things work (or don't)...

The Health and Disability Advocates might be a good resource for anyone who

needs immediate assistance...312-223-9600.

Ellen

Ellen Garber Bronfeld

egskb@...

Possible increase in insurance coverage denial as a

result of our new Autism Law??

" Illinois Parents of Adult " <IPADDUnite

<mailto:IPADDUnite%40> >, " Autism chicago "

<AutismNews <mailto:AutismNews%40> >

Date: Wednesday, December 24, 2008, 12:28 PM

Just curious, has anyone experienced, or heard of others experiencing, an

increase in denials of health insurance coverage as a result of our new

Illinois Autism Law?

I have always expected a larger premium for families with a child with

Autism, but having just received a " denial of health care coverage " for my

sons because of their Autism, I am wondering what good the law will do us

all if insurance companies begin/increase their denials of health insurance

coverage for families affected with Autism. Isn't this just a way for them

to get out of complying with the new law. And this denial comes from a very

reputable Illinois insurance company (BCBS of Illinois).