In 2011, California parent advocates were able to get the nation’s most progressive Autism Insurance Mandate bill signed into law. The law states that all California-governed health insurance companies must pay for diagnosis and evidenced-based treatment for Autism NO MATTER the person’s age or IQ. Typically families access ABA (sometimes call BHT or Behavioral Health Treatment), speech and occupational therapy services. While the new law was a big success, it still can be challenging to navigate through your health insurance for Autism services. Two people could have Blue Cross Blue Shield, but have different benefits depending on the company that employs them. The first place to start is to call the number on the back of your medical health insurance card and ask about Autism benefits. A member service representative should be able to tell you what services you qualify for, and what are the co-pays and deductibles for using the services.
Medi-Cal families: As of July 1, 2018, families no longer need to have a Comprehensive Diagnostic Evaluation (CDE) to start Autism treatment. A CDE is considered best practice, but the waiting times can be very long (6 months or more). You can get on the list for the CDE, but ask your primary care provider to write a referral to start ABA, speech, and occupational therapy (whichever is medically necessary).
Note: California Insurance companies have an obligation under the California Timely Access Law that non-urgent appointments with specialists will have to be set within 15 business days. If this process is not being followed, you may file a complaint or grievance with your insurance company. If this does not resolve the issue, you may file a complaint with the California Department of Managed Health Care.
Autism Deserves Equal Coverage – Kristin Jacobson
1534 Plaza Lane, #202, Burlingame, CA
(650) 260-5305
https://autismcoverage.org/
Advocates and works with providers, families, therapists, ABA agencies, Regional Centers and other organizations in securing insurance to cover medically necessary treatments for Autism, including ABA, Speech, OT, PT, Social Skills, and Evaluations. Negotiates with health plans, insurance companies, and state and federal regulators to fund services for Autism.
California Department of Managed Health Care
1 (888) 466-2219
www.hmohelp.ca.gov
Has trained staff to help consumers, including those with Autism spectrum disorders resolve their health care issues in a timely manner. The Help Center can assist you when have been denied the following treatments or are dissatisfied with your health plan’s resolution of a grievance: Applied Behavioral Analysis (ABA), speech therapy, occupational therapy, physical therapy, and/or specialty diagnostic testing, or a referral to a specialist not available within the medical group. The Center will work to resolve disputes. If a health care service has been delayed, denied or modified by your health plan because it was deemed not medically necessary, experimental or investigational, you have the right to an independent medical review. The resulting determination is imposed on the health plan, which is required to comply with the decision of the reviewers within a specific time frame.
The Law Offices of Scott Glovsky
343 Harvard Avenue, Claremont, CA
299 N. Euclid Avenue, Pasadena, CA
(626) 669-1634
www.fighthmos.com
Law practice emphasizes insurance bad faith, catastrophic personal injury, employment and health-related litigation. Law Practice fights health insurers, life insurers, disability insurers, property insurers and liability insurers; and helps individuals fight health insurance companies and health plans to obtain appropriate treatment for their medical conditions and reimbursement for denied medical treatment.
Medi-Cal Consulting Services, Inc
417 South Sherman Ave., Corona, CA
1 (877) 633-4435
www.medihelper.com
Provides free consultations. Medi-Cal Consulting Services can guide you through the eligibility qualification process, fill out necessary forms and meet with Medi-Cal workers on your behalf. Comprised of former Medi-Cal workers with over 40 years of experience. Se habla español.
Mental Health & Autism Health Insurance Project
3559 Mt. Diablo Blvd, Lafayette, CA
(925) 388-0892
https://mhautism.org/
Provides free initial consultation, advice, direct assistance and advocacy including letter writing, argument formulation, documentation preparation, advice on coding and billing. Sliding fee scale available based on household income.
Autism Society Options Policy
This Resource Guide was developed to provide families and professionals with an opportunity to find resources related to autism in the Inland Empire in one place.
All information provided or published by the Autism Society Inland Empire is for information purposes only. Specific treatment, therapy or services should be provided to an individual only at the direction of the individual’s doctor, caregiver, or other qualified professional. References to any treatment or therapy option, program, service, or treatment provider are not an endorsement by the Autism Society. References of treatments, therapies, programs, services, and/or providers are not intended to be comprehensive statements. You should investigate alternatives that may be more appropriate for a specific individual. The Autism Society assumes no responsibility for the use made of any information published or provided. The Autism Society Inland Empire provides information, but it does not constitute medical or legal information. Referrals provided are suggestions to organizations that might help, but do not constitute a recommendation. The Autism Society Inland Empire cannot be held responsible for consequences that arise from individual dealings with a professional or organization. The inclusion of any organization does not imply endorsement, and omission does not imply disapproval. The Autism Society Inland Empire may add or remove organizations from this list at its discretion.
