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How Private Insurance Can Help With Private Education For Autism

For children with autism, education includes a lot more than reading, writing and arithmetic. 

In addition to academics, children with autism need a range of behavioral, occupational, speech and physical therapies. Each unique case and curriculum will look a little different.

Although some services are available at public schools, it’s not always enough. You may feel that a private education is the best option.

Costs Of Private Education For Children With Autism

The CDC estimates that it costs $17,000 per year to treat a child with autism. For children whose cases are severe, the CDC estimates costs over $21,000. Not everyone has that kind of cash, and insurance hasn’t always been helpful. It wasn’t until recent years that lawmakers began mandating autism insurance coverage. 

So, does private insurance coverage pay for a private education? 

The answer is: It depends on your plan. 

Take these 5 steps to understand your health plan and your rights, and learn how private education for your child might be more affordable than you think.

1. Determine What Type of Health Plan You Have

Your health plan will indicate what regulations govern its benefits. You will likely have a fully funded, self-funded or individually funded plan. 

Fully funded means an employer purchased a health plan from an insurance company. Fully funded plans are covered by state insurance mandates, the Affordable Care Act and the federal mental health parity law

Self-funded means that employers have put money aside to fund employees’ health coverage. Self-funded plans are not covered by state insurance mandates. They are covered by some parts of the Affordable Care Act, and, with some exceptions, the federal mental health parity law.

Individually funded means that a person purchased his or her own health insurance. This person might be self-employed or opted to buy individual insurance not available through an employer. These plans are usually governed by state laws but they are not always bought through private companies.

You can determine what type of insurance you have by asking your employer’s human resources department or calling your insurance company. Autism Speaks provides helpful information on understanding this topic.

2. Understand Your Essential Health Benefits

Not everyone has the gold-standard of health insurance plans, which will cover all of your children’s needs. But, certain benefits ensured by the Affordable Care Act might make it easier for you to afford some essential needs for your child. 

The Affordable Care Act requires that certain health plans (some individual health plans and employers’ non-self-funded small-group plans) cover “Essential Health Benefits.” 

Essential Health Benefits cover ten basic services, including mental health services and habilitative services. This type of coverage can make affording private education for autism easier, as it might help pay for services like Applied Behavior Analysis, occupational therapy, speech therapy or physical therapy. 

3. Learn about Mental Health Parity Laws

Federal and State Mental Health Parity Laws prevent insurers from placing limits or caps on mental health services, which are more restrictive than those placed on medical or surgical services. This means that those seeking coverage for autism-related occupational therapy cannot incur higher co-pays or caps on visits than a person seeking the same services due to an injury.

Depending on your health plan, Mental Health Parity Laws can help you ensure coverage for your child. If you are denied coverage for a certain benefit, but determine that the same benefit is covered for a comparable medical or surgical need, you may be able to enforce your rights under Mental Health Parity Laws. Here are two resources to learn more: 

4. Understand Virginia’s Mandate for Autism Insurance Coverage

In 2019, Governor Northam signed into law a mandate for autism insurance coverage, which eliminates the age cap for coverage of diagnosis and treatment of autism. Under this new legislation, which will go into effect on January 1, 2020, autism patients can receive coverage for life. 

Coverage will provide for “medically necessary” services, as deemed appropriate by a licensed physician or psychologist. Services can include:

  • Behavioral health treatment
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care (including occupational therapy, speech therapy, physical therapy & more)
  • Applied Behavior Analysis

5. Call Your Insurance Company

Making a call to your insurance company shouldn’t be just one step you take–it should become a practice. Begin by making a call to understand what type of health plan you have and how autism services are covered. 

As your child’s treatment progresses, call your company often to follow up on claims, paperwork and bills. The more engaged in the process you are, the more confident you will become in understanding it. 

When you call, have your child’s medical and school records in front of you, as well as a list of questions. Consider these to start:

  1. What type of health plan do I have?
  2. What autism services are covered? Do these include services provided by a private school for autism?
  3. What process do I need to go through to get authorization for services?
  4. Are there limitations on any services?
  5. What deductibles and co-pays am I responsible for?

If you encounter resistance or you are confused, ask about your Essential Health Benefits or your rights under Virginia’s autism mandate or Mental Health Parity Laws. 

Read More About the Benefits of Choosing a School for Autism

If you find the right school setting for your child, you can experience the peace of mind you’ve been hoping for. At a school like Sarah Dooley Center for Autism, your child will be in the hands of trained, caring professionals whose life’s mission is to help your child succeed. 

Read more about the ways our community can give your child the best education possible.