Special Needs

How to Tackle Autism and Insurance Coverage

| by TACA

Holly Bortfeld

My son Max is the "million dollar man." In the ten years since he was diagnosed, he’s had one million dollars worth of therapy and treatments. One Million Dollars. Wow! Did I have a million dollars to spend on him just sitting around in the bank? No. Not even close. If you are reading this, I bet you don’t either.

When he was diagnosed, the doctor told me he’d never speak again, do math, be potty trained, have relationships and care about people, that he would injure himself and others and would never improve or be able to even live at home. I was devastated.

Thankfully, with therapy and treatment, we proved that doctor very wrong and my son is a thriving, lovely boy. These therapies and treatments have benefitted him so much and changed his outlook for a long healthy, happy, functioning life. My son deserved every dollar of it. So does your child!

Why is Treating Autism Important From the Traditional Intervention and Biomedical Perspective?

It is important because autism is diagnosed so young and CAN affect individual’s life long, but does NOT affect the life span of an individual. We know from best practices that treatment is important and is altering outcomes for individuals affected.

If we treat autism spectrum disorders based on their unique biomedical and traditional therapy needs – the life long estimated costs for an individual from $3-7 million dollars may be changed from being an expense to becoming a tax payer. There are children that recover from autism and that will go on to lead normal lives.

This data is still emerging. The CDC reports that 80% of those affected with autism are UNDER the age of 17 years. We owe it to these children, and their families, to not ignore the “problem” but to treat it like in any other disorder. These guidelines outline one responsible party (just health insurance) in what should be required by law.

Parents need to use their best judgment, information, state and federal laws to help their children become the best they can be – with the hope of recovery and the possibility of becoming a taxpayer. After all – that is our job as a parent.

Sure, there is a lot to learn when your child is diagnosed. First you get to learn about the disorder itself, then learn about the many confusing treatments and approaches, then try to guess which ones will benefit your particular child and lastly you get to figure out how to pay for it all. The process can get overwhelming very quickly.

I emptied all of our savings, 401K, filled credit cards to their limits and borrowed money from relatives to help my son. Eventually, there was no money left and no one else from which to borrow anymore. That’s why I wrote this article – to give you the tools so you don’t have to do what I, and thousands of other families, did. Getting companies to cover what your child needs can be difficult, very difficult at times, but not impossible.

Why Should I Bother Learning All of This?

Speech Therapy costs:

-- $75 per 30 minute session, 3 times a week for 50 weeks a year = $11,250

Occupational Therapy costs:

-- $75 per 30 minute session, 3 times a week for 50 weeks a year = $11,250

ABA Therapy costs:

-- $120 per hour for BCBA to oversee program, 10 hours a month, 12 months a year = $14,400 plus $30 per hour for 1:1 therapist, 30 hours a week for 50 weeks a year $45,000 (not to mention materials)

Bottom Line:

-- $81,900 per year per child will break the bank!

Getting your insurance company to pay their share will allow your child a real chance at a future and you shouldn’t have to lose everything to do it.

You should not be going broke treating your child with autism. This article aims to shed some light on the process and help you navigate the system to get your child the help s/he needs. This is not meant to serve as legal or medical advice and is NO guarantee of coverage, but I hope it will arm you with some information to help you help your child.? Good Luck!

Insurance Coverage-on-a-Budget Links

Insurance Pays for What?
Insurance for Beginners
How to Start Working with Your Insurance Company
Billing Codes That Work
Appealing an Insurance Denial
What is ERISA-Employee Retirement Income Security Act?
Health Savings Accounts
Tax Strategies for Parent of Children with Special Needs
Autism Insurance Legislation
State Medicaid
Autism Insurance Resources
Definitions Relating to Insurance
Supporting Research for Treatments of Autism
Lab Tests with Cost and Codes (CPT)
Common Co-Morbid Disorder Diagnosis Codes



This list is dynamic and will change as parents give us feedback on what worked and didn’t work for them. Please check back occasionally and send us any codes that worked successfully for you. Nothing in this document is to serve as medical or legal advice. The codes included are to be used as a GUIDELINE and there is no guarantee of coverage but we hope this will help you get the help your child needs.

This article is for informational purposes only and is not meant to be construed as tax, legal or medical advice. Please contact your tax, medical or legal consultant for verification.