I have 2 boys on the spectrum, one with Asperger's and the other with PDD-NOS. They require ABA, ST, and OT, and have been evaluated by doctors and specialists.
I work for a company that has a "self-insured" health plan through Blue Cross that has absolutely NO autism benefit. In other words, the plan doesn't pay for ANY autism-related treatment, diagnostic tests, etc. Even though Illinois law mandates an autism benefit that includes ABA, OT, etc., my company does not have to abide by it because we are self-insured (as ore 50% of company plans in the US). The last company I worked for was also self-insured.
My question is this: how will the Patient Affordability Act (Obamacare) change any of this? I saw that ABA, ST, OT, etc. may be classified as an "essential service" for health plans, but according to what I have read, this is only for individual and small-market plans: firms with over 50 employees that are self insured will not have to abide by this (and that is literally hundreds of thousands of policy holders).
Will I be able to drop my health plan at work and go to the insurance exchanges when they open in 2014? Or will I not be allowed to do this because I am covered by my employer?
Can I get private insurance that will cover ABA? Or is this next to impossible, or totally unaffordable?
We live in an apartment right now and pay $1200 out of my own pocket for ABA, ST, OT, etc. I can't buy a home because of my healthcare costs.
We home-school, and even if we enrolled the children in the local district, it wouldn't give us ABA or enough ST,OT, etc. We already checked on that.
I can't believe that my choices are either move to France or get no Autism treatment! What can I do?
11 Apr 2011, 11:49 am
