A colleague of mine is seeking coverage for Autism. Do we really have such coverage?
Total Comments: 5
Posted: Wed Jun 09, 2010 12:09 am Post Subject:
Autism will be covered by standard medical insurance if approved for coverage. Obtaining coverage under individual insurance is questionable, group insurance is not an issue.
Posted: Wed Jun 09, 2010 09:17 am Post Subject:
Autism will be covered by standard medical insurance if approved for coverage.
The cost of coverage will be much more if Autism gets added to it. Don't you think so?
Posted: Wed Jun 09, 2010 11:07 am Post Subject:
Probably so, Steven, but this is not unusual -- there are hundreds of conditions that require special consideration from underwriting. Consider diabetes, high blood pressure, various cardiac disorders, all of which have substantial associated health risks. Persons who have had silicone breast implants, who may be perfectly healthy otherwise, are almost always declined automatically because of the risk of cancer or other complications if the implant were to leak or rupture, while women with saline implants could be accepted as a standard risk.
Aside from medications and behavioral counseling, persons with autism don't necessarily experience other adverse health events more frequently than persons the same age without the disorder. That's what is of greater concern to underwriters -- what can be expected in the future?
The real question is whether the insurer will even accept the risk or not. Blue Shield of California's underwriting guidelines state applications for persons under age 18 with autism "may" be declined without medical review, but persons of any age with autism may be accepted at a higher "tier" (substandard rating) if "testing is complete" and depending on the treatment necessary.
After age 18, for example, the person who has been living with autism for many years (12-15 or more) will most likely have a sufficient medical history that they may not be any more substandard than a Tier 2 rating (+25%) -- the same rating that some persons who have been treated for depression might receive. Standard rating? Probably not.
Posted: Thu Jun 10, 2010 10:38 am Post Subject:
I've come to know that only treatments that are effective will be covered under such coverage. You may only be covered to go for behavioral therapies rather than going for it's developmental alternatives.
Posted: Fri Jun 11, 2010 06:28 am Post Subject:
You may only be covered to go for behavioral therapies rather than going for it's developmental alternatives.
The autism treatments that are proven as 'effective' are quite less in number. Behavioral therapies as you call them are not known to be that much effective or appropriate. Overall, insurers have lesser risks to cover for.
Posted: Wed Jun 09, 2010 12:09 am Post Subject:
Autism will be covered by standard medical insurance if approved for coverage. Obtaining coverage under individual insurance is questionable, group insurance is not an issue.
Posted: Wed Jun 09, 2010 09:17 am Post Subject:
Autism will be covered by standard medical insurance if approved for coverage.
The cost of coverage will be much more if Autism gets added to it. Don't you think so?
Posted: Wed Jun 09, 2010 11:07 am Post Subject:
Probably so, Steven, but this is not unusual -- there are hundreds of conditions that require special consideration from underwriting. Consider diabetes, high blood pressure, various cardiac disorders, all of which have substantial associated health risks. Persons who have had silicone breast implants, who may be perfectly healthy otherwise, are almost always declined automatically because of the risk of cancer or other complications if the implant were to leak or rupture, while women with saline implants could be accepted as a standard risk.
Aside from medications and behavioral counseling, persons with autism don't necessarily experience other adverse health events more frequently than persons the same age without the disorder. That's what is of greater concern to underwriters -- what can be expected in the future?
The real question is whether the insurer will even accept the risk or not. Blue Shield of California's underwriting guidelines state applications for persons under age 18 with autism "may" be declined without medical review, but persons of any age with autism may be accepted at a higher "tier" (substandard rating) if "testing is complete" and depending on the treatment necessary.
After age 18, for example, the person who has been living with autism for many years (12-15 or more) will most likely have a sufficient medical history that they may not be any more substandard than a Tier 2 rating (+25%) -- the same rating that some persons who have been treated for depression might receive. Standard rating? Probably not.
Posted: Thu Jun 10, 2010 10:38 am Post Subject:
I've come to know that only treatments that are effective will be covered under such coverage. You may only be covered to go for behavioral therapies rather than going for it's developmental alternatives.
Posted: Fri Jun 11, 2010 06:28 am Post Subject:
You may only be covered to go for behavioral therapies rather than going for it's developmental alternatives.
The autism treatments that are proven as 'effective' are quite less in number. Behavioral therapies as you call them are not known to be that much effective or appropriate. Overall, insurers have lesser risks to cover for.
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