Guest guest Posted January 27, 2011 Report Share Posted January 27, 2011 CMS will not cover ABA therapy. I am wondering about what the term fully-funded means? Re: Moving to the Area We just got the approval for the insurance to cover $36k per year for therapies including ABA. But my husband basically had to change jobs to a company that meets the criteria for the law. Unfortunately, only about 15% of children with autism in Florida actually are able to take advantage of it. It has to be a group insurance and the plan has to be Fully Funded not Self funded. The insurance plans needs to be written in Florida and the company has to insure more than 50 or 60 employees. Since the new company he works for meets this criteria we were able to get it without any trouble. After fighting insurance for 2 years at his previous job and paying out of pocket for so long, this went surprisingly quick and we were assigned a case worker who specializes in autism. If your friend qualifies for medicaid she can get CMS which will also cover therapies. But I think the income requirement is very low. It is definitely worth looking into when considering a move. For us, it is saving us from financial ruin! Shiri > > Hello Guys, > > I have a friend who might be moving to the Boca/Deerfield area. She was wondering if anyone could give her information on schools in that area. She's also wondering how the state mandated insurance coverage is working and what it covers. How do you qualify for medicaid and how long it takes to kick in as well as home program, assistants and respite care. She's also curious about the McKay Scholarship just in case she's not happy with the area school. Feel free to email me privately. > > Thank you! > Sent on the Sprint® Now Network from my BlackBerry® > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2011 Report Share Posted January 28, 2011 A couple of interesting points... CMS Title 19 does not cover ABA therapy, whereas CMS Title 21 does. This reigns true for the Broward, West Palm and Fort Pierce counties. Each county operates differently as far as CMS provisions, but it is definitely worth looking into in any Florida county. Second, the main difference between fully funded and self funded is who actually controls the plan. A self-funded plan is a plan where the empoloyer/group holding the policy actually controls the policy. What this really means is they pick and chose which items in the plan are and are not covered. ABA will almost always likely not be something included in these plans. A fully funded plan is a plan in which the actual insurance agency controls the plan. That being said, the insurance agency, being under the state mandate of coverage for ABA benefits, will offer this to the extent of the law. Hope that helps! -Carol Sedra > > > > Hello Guys, > > > > I have a friend who might be moving to the Boca/Deerfield area. She was wondering if anyone could give her information on schools in that area. She's also wondering how the state mandated insurance coverage is working and what it covers. How do you qualify for medicaid and how long it takes to kick in as well as home program, assistants and respite care. She's also curious about the McKay Scholarship just in case she's not happy with the area school. Feel free to email me privately. > > > > Thank you! > > Sent on the Sprint® Now Network from my BlackBerry® > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2011 Report Share Posted January 28, 2011 I know, but at least CMS covers ST and OT, I couldn't even get that covered with my previous insurance and it was a $2K a month PPO plan! They just hear autism and they start looking for every known loophole in order to deny us. Fully-funded means, I think, that the employer buys a plan with a premium that fully covers the plan itself. In other words, if employees grossly exceed the amount of what is expected for them to use like an expensive illness/surgery etc.. then the insurance company must cover it. Self funded means that the employer buys insurance with a cap, and if the employees exceed it then the employer is responsible for it. Here's an explanation: http://www.physicianscare.com/content/public/default.aspx?id=330 Shiri > > > > Hello Guys, > > > > I have a friend who might be moving to the Boca/Deerfield area. She was wondering if anyone could give her information on schools in that area. She's also wondering how the state mandated insurance coverage is working and what it covers. How do you qualify for medicaid and how long it takes to kick in as well as home program, assistants and respite care. She's also curious about the McKay Scholarship just in case she's not happy with the area school. Feel free to email me privately. > > > > Thank you! > > Sent on the Sprint® Now Network from my BlackBerry® > > > Quote Link to comment Share on other sites More sharing options...
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