In the early days of an autism diagnosis, many parents are instantly told to speak with their insurance, find out what is covered, and obtain a list of covered providers. Like with any other disability or medical need, what insurance covers tends to vary between states and between plans.
While navigating the enormous variety of programs now available to those on the autism spectrum, you will need to become familiar with what your insurance is mandated to provide to make the most of your resources.
If you have a child residing in Washington State, all private health plans must provide coverage to treat autism medically. It is the same for plans through the healthcare marketplace. Below are some common questions our parents ask, as well as answers specific to Washington State.
My Child Is Not Diagnosed. What Parts Of The Diagnosis Process Are Covered?
According to Washington State law, universal autism screenings are required. At 18 months old and again between 24 and 30 months, children will receive an autism screening questionnaire through their pediatrician. To obtain a diagnosis in this state, you will need to make an appointment to see a neurologist, psychiatrist, psychologist, or developmental pediatrician.
Though you can expect the diagnosis to be covered, the amount you owe for the actual diagnosis appointment will depend on your specific insurance coverage, if there is a copay, and if there is a family deductible. The provider you choose for the diagnosis will help you with this process.
Is ABA Therapy Covered By My Insurance?
Through the Washington State Autism Insurance Law, health insurance plans are mandated to ensure young people with autism have access to evidence-based treatments, such as applied behavior analysis (ABA) therapy. This coverage lasts until the age of 21, making it possible for children to access services during their most critical period of development.
In Washington State, there are no limits on coverage or visits, and the BCBA (Board Certified Behavior Analyst) who provides your child the ABA therapy must be licensed or certified.
In recent years, ABA has been determined to be a medically necessary form of therapy for autism spectrum disorder, requiring insurance plans to cover those services.
What Additional Therapies and Treatments Are Covered?
In Washington State, parents have access to the ESIT program (Early Support for Infants and Toddlers). This program provides services to children from birth to age three who have developmental delay or disabilities, including autism. This program provides a range of services, including assessments, therapies, and family support, to help young children with autism develop important skills in their early years.
In addition, all private health plans and marketplace health plans must provide coverage for other medically necessary treatments, including physical therapy, occupational therapy, speech therapy, and mental health services.
Apple Health and Autism
A key program available in Washington State is Apple Health, the state’s version of Medicaid. It provides health insurance coverage to low-income families with children and young adults with autism. Apple Health covers a wide range of services for individuals on the autism spectrum, including behavioral health services, therapy, and medication management.
Gersh Academy at Cougar Mountain is dedicated to providing students with the individualized resources to help them thrive. We aim to offer quality services to all our students who need them, including speech therapy, occupational therapy, physical therapy, equine therapy, and counseling services. All of these services are included in your child’s day. If you feel your child could benefit from our school, reach out here.
Resources:
https://www.ncsl.org/health/autism-and-insurance-coverage-state-laws
https://apps.leg.wa.gov/rcw/default.aspx?cite=48.44.450
https://www.appliedbehavioranalysisedu.org/state-by-state-guide-to-autism-insurance-laws/#washington
https://www.hca.wa.gov/about-hca/programs-and-initiatives/apple-health-medicaid