| Children With Autism (CWA) Medicaid Waiver Information
Health
Insurance Information and Resources
Several major commercial (State of Colorado) health insurance
carriers have agreed to cover autism as a "congenital (birth)
defect" and pay for 20 visits each of medically necessary
speech therapy (ST), occupational therapy (OT)and physical
therapy (PT) as provided by the State of Colorado health plan
mandate.
Cigna and United Healthcare, at the request of the Autism
Society of Colorado (ASC) and Family Voices of Colorado, agree
that they would no longer deny claims for ST, OT and PT on
the grounds that autism is not a congenital defect. These
groups join Anthem and Rocky Mountain Health Plans who already
cover autism as a congenital defect.
In the recent past, many private, commercial health insurers
have denied claims for these therapies granted through this
mandate to treat autism by claiming that autism didn't fit
the criteria they used to be considered a congenital defect.
"Acknowledgement by the State of Colorado health plans that
autism is congenital anomaly is a big victory for families
in Colorado," said ASC Executive Director Betty Lehman. "This
is a good start and now that the health plans have this basic
understanding of autism, we intend to continue our focus of
having health plans be players in the cost of treatment for
autism families in Colorado, Lehman added."
Important items to note:
- while this change affects the private, commercial plans
of the insurers listed here, you can use this example to
show another carrier that autism is indeed considered a
congenital defect by leading insurers in Colorado;
- this only affects private, commercial plans in Colorado.
Other plans such as federal or self-funded plans may use
one or more of these carriers to process their claims but
they are not commercial plans. Read your plan or consult
with your employer's human resources/benefits staff if you
are not sure;
- if you have been denied coverage for the above services
based on the criteria that autism was not a "congenital
defect" in the past 12 months, you can re-submit your claim
along with a copy of this alert;
- please download this letter
of support from the American Academy of Pediatrics that
was instrumental in bringing about this important change.
If you continue to be denied coverage by your insurer or
if you have questions, please contact:
Sarony Young at Family Voices of Colorado
Phone: 1-800-881-8272
Email: sarony@familyvoicesco.org
Website:
www.familyvoicesco.org
NOTE: 2/26/05: United
Healthcare has asked ASC to clarify their coverage of autism
on Colorado commercial plans. Their letter states that
they have added autism to their list of conditions under which
speech therapy is a covered benefit. However, the letter further
states that they have not included autism as a congenital
defect or birth anomaly — conditions which they are
obligated to cover only up to age five. This action by United
Healthcare has no such age limitation. Click on headline or
Here
More Insurance Information
Medicaid Information and Resources
Colorado's Children with Autism (CWA) Medicaid Waiver and other Children's Waivers
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