United Healthcare Choice Policy Issue - 3/23/11

Dear Autism Families,

UnitedHealthcare appears to have made several errors or to be unclear in its “Choice” policy regarding coverage for autism treatment under HIMAT (Health Insurance Mandated Autism Treatment).

We have called United and are hopeful that any errors and other concerns can be collaboratively resolved as soon as possible.  In the meantime, we want to notify the autism community right away regarding two of our concerns that are readily identifiable.

The policy that we had the opportunity to review is titled “UnitedHealthcare Choice”.  The terms that we are concerned about are contained in an “Autism Spectrum Disorders Amendment” (the bottom left corner says AUTISM.AMD.1.09.CO and the bottom right corner says 2009/C.CP.OPT.NDF).  This Amendment may be part of other United policies as well.  (If you do not have a copy of your complete Policy (often the Certificate of Coverage plus any Amendments plus a Schedule of Benefits), you can request one from your human resources manager or by calling the customer service number on the back of your card.)

Our first concern addressed here is that United states that behavioral treatment must be provided by or under a psychiatrist or psychiatric provider.  We believe this is NOT CORRECT because, under HIMAT, behavioral treatment may be provided by any person who satisfies one of the six categories of providers referred to as an Autism Services Provider.

Our second concern addressed here is that United states that several treatments must be provided in accordance with a treatment plan that is prescribed and signed by the person’s treating physician.  We believe this is NOT CORRECT because, under HIMAT, a treatment plan may be written by an Autism Services Provider and treatment can be prescribed by a licensed physician or a licensed psychologist.

Again, we hope to work collaboratively with United to address these concerns and others that require clarification and detailed conversation.

HIMAT requires certain private health insurance policies to provide coverage for seven categories of treatment for ASD.  See the Overview document for more information, including the date on which coverage will begin (qualifying policies will begin coverage on different dates), which policies get the benefit of this mandate, which treatments are covered and who qualifies as an Autism Services Provider.

Please note that this does not constitute legal advice.  ASC serves the autism community in many ways, including disseminating information and pursuing public policy initiatives.  Please consult legal counsel for further information.

Best Regards,

Jill Tappert
Proud mother of Abigail (medically-fragile and diagnosed with Autism, ADHD, Anxiety NOS, Sensory Processing Disorder, Motor Discoordination) and Calvin (NT)

Director of Private Insurance Policy, Autism Society of Colorado

Anthem Blue Cross and Blue Shield made a significant error in its Standard PPO Policy regarding coverage for autism services.

In the bottom left corner of the policy itself (the long document about the policy, often referred to as the “Certificate of Coverage”) is the number BA81 and the document file name 95981_PPO Standard (Rev. 7-10).  (You may not have a copy of your Certificate of Coverage, but can request one from your human resources manager or by calling the customer service number on the back of your card.)

At the top of page 38, Anthem states that “Treatment for Autism Spectrum Disorders … must be provided by an Autism Services Provider.”  This is INCORRECT because only some of the treatment services that are covered must be provided by an Autism Services Provider (a provider who satisfies certain requirements).   A new law (HIMAT) requires certain private health insurance policies to provide coverage for 7 categories of treatment for ASD.  Only 2 of those 7 categories are tied to an Autism Services Providers or other specific providers.

It is our understanding the Anthem agrees that this is an error and is presently working with the Division of Insurance to correct the policy language.

See the Overview Document (linked above) for more information regarding HIMAT, including the date on which coverage will begin (qualifying policies will begin coverage on different dates), which policies get the benefit of this mandate and which treatments are covered.

Best Regards,

Jill Tappert
Co-Chair, Public Policy Committee
Autism Society of Colorado