California Health Insurance Coverage for Autism

Autism Insurance Coverage in California is a Reality

Your Health Insurance may now pay for Applied Behavior Analysis (ABA) services for your young or adult child with Autism Spectrum Disorder (ASD). The California Department of Insurance has already reached settlements with the following health insurance companies to ensure autism coverage:

  • Blue Shield of California
  • Health Net
  • Cigna
  • Anthem Blue Cross of California

The Department of Insurance obtained agreements from the health insurance companies to stop the following:

  • Denying ABA therapy as a non-covered service
  • Challenging the medical necessity of ABA treatment
  • Forcing parents into an unnecessary Independent Medical Review to secure treatment

In February 2012, California Insurance Commissioner Dave Jones announced the following:

“We are pleased that Health Net and Cigna now recognize their current obligations to provide crucial behavioral health treatment to the thousands of children who must live with autism every day,” said Commissioner Jones. “And we are pleased to reconfirm and acknowledge Anthem Blue Cross of California for providing this treatment as the Department of Insurance has directed since November 2009.”

Most importantly, there is no upper age limit to this law, which means that adults with ASD will be able to receive the necessary ABA treatment, to help them begin to lead more independent and fulfilling lives.

These agreements mean that parents and other caregivers will no longer have to worry about whether or not they can afford a therapy that’s been proven to transform lives of individuals on the autism spectrum.  This is particularly important in California, due to the recent uncertainties of continued regional center funding.

Details of California’s Legislation for Autism Insurance

California Insurance coverage for individuals with ASD has been mandated with the Legislature’s passage of SB 946 (known as the Autism Insurance Act) and it will go into effect July 1, 2012.  SB 946 requires fully funded insurance plans to cover medically necessary autism treatments and it specifically includes the only scientifically-proven procedure, ABA.  This law compliments and strengthens California’s AB 88 law which was passed in 2000.  Also known as the Mental Health Parity Act (MHP), AB88 requires insurance companies to offer treatments for autism along with other disorders.

Let Vista tell you how to get started looking into autism insurance coverage

Are you a candidate for getting health insurance coverage for autism treatment?  Answer these questions:

  • Do you live in California?
  • Has your loved one received a prescription for “behavioral health treatment” from a physician or a licensed psychologist?
  • Do you have a fully funded health insurance plan that has a behavioral health component?

If you answered YES to these questions, you may qualify for coverage for medically necessary behavioral health treatment, particularly including Applied Behavior Analysis.

We understand this process and we will help you to navigate the complex insurance system. Please let us apply our knowledge and experience to educate you about getting  insurance coverage for your loved one’s ABA therapy.