Autism & Medical Insurance

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Hi All,

We are heart broken and broke into tears when my child of age 1 Year 10 Months got diagnoised with Autism. We need some help in terms of Insurance Plans for our Kid. Actually at the time of Birth and till he is 6 Months old we have Insurance coverage for my Kid. After Six Months my Wife and Kid went to India for 1 Year and 3 Months and my Employer discontinued the Insurance as they are outside of the Country. Which makes Sense. But when I asked the present Insurance Company to add my Kid and Wife to my Health insurance they said it is ok to add, but there is clause that states, prexisting conditions are not covered for 1 Year. Will Autism be treated as Pre Existing Condition. The diagnoises is done in India but not in USA. Here may be Doctors need to do lot of Screening to decide wether it is Autism or Something else.

How to tackle this situation and How can I have my kid covered for Insurance. I live in NJ and my Kid is Citizen of USA. I wanted to go for all the possibilities of Insurance to ensure that my kid gets a better treatment with Intensive Therapies. So that he can mould at this age.
I know there is a plan called NJFamilyCare but will it give adequate coverage for my kid who needs Special Therapies like occupoational, SPeech Therapy etc ?

Your replies will be much appreciated in these toughest situations

Thanks,
Sana

At less than 2 years of age, your child is a little young to get an accurate assessment of her condition, or to benefit much from any treatment programs. Since the assessment was done out of the country, and not on any previous or current insurance, and was done before a truly accurate assessment could be done, I would not mention it to the current insurance company. Instead I would have her put on the current policy, then wait until she is about 2 1/2 to 3 years old to have her evaluated by a doctor here in this country, if you still think she may be on the Autism/Asperger's spectrum. Before that age it is really not possible to get a good idea of whether a child is on the spectrum or not, and they are too young to really participate in any treatment programs anyway. Also, if you have noticed problems she is having, it could just be that she is a little slow to advance at this phase of her life. The wait would give you a better idea of whether she really needs to be checked out or not, so telling the insurance company at this point in time is premature. So take several deep breathes and calm down. Have her put on the policy without the foreign diagnosis, as it really is too early to make such an assessment.

I agree with Questor that you should wait, but I say it for a different reason. Unless your child is having problems, it would be best not to bring it up to doctors yet. It WILL be considered a pre-existing condition, and WILL affect the premiums you have to pay. (I don't know if the provision Rascal mentioned is in effect yet, but I know that a lot of the provisions don't start until 2014. It would be important to look into, for sure.)

So if your child needs some sort of assistance, you don't have much of a choice. Having a diagnosis would be a great help in that case. But if your child seems to be getting along fine, learning at a proper pace, etc., definitely put off (or avoid, if it never even becomes a big issue) a diagnosis. All it will do then is make you spend more money.

That's why I haven't gotten a diagnosis. I survived childhood without one, but if I got one today it would do no good, just make my insurance more expensive. Of course, again, I'm an adult, not a developing child. Just stay alert and supportive of your baby. I'm sure you'll know what to do and when to do it if ever an issue came up.

I tried to get health insurance yesterday. The salesman called me up. As soon as I mentioned the word 'autism' it was like a red flag got thrown up. He said no health insurer would touch me with a 10 foot pole because I have a pre-existing condition. I said, "Oh, it's only Asperger's, not the full blown thing." He said it doesn't matter because I'm still on the spectrum. He told me to look into Washington state preexisting health insurance program. So I did. Whereas regular health insurance (Group Health, Humana, etc) would cost me about $300/month, the preexisting one would cost around $950/month! Now where am I supposed to get that kind of money? Off a tree?

There are no free clinics where I live. They do have Neighborcare things in several neighborhoods. I joined one. My co-pay is $75/visit. I could just afford to go there about once a month. Medication isn't subsidized so I have to look around for the cheapest pharmacy with my prescriptions. I have to pay the full co-pay because I'm just above the gov't poverty guideline level which they - and Medicaid - go by. Could be worse. I could be homeless living out of a shopping cart under a bridge.