Tag Archives: Insurance

Question?: Adhd Medications

Ken asks…

Is there a way I can get cheap ADHD medication without insurance?

Right now, I don’t have insurance and I can’t afford it. Not only that, but I also have ADHD. I’m really trying to bring it under control, but it’s very hard. Is there any way I can get cheap ADHD medication without insurance?

admin answers:

Partnership for Prescription Assistance lists initiatives sponsored by drug manufacturers and by government and local organizations to help uninsured people with medication costs. See the link below.

Your doctor may be able to help with samples, but that won’t last you long.

Most ADHD meds are stimulants, so it may help to “self-medicate” with caffeinated products like coffee or coke. Obviously this isn’t a long-term solution, but it may help you ride out the bumpy times.

P.s. I had already checked the Walmart site and didn’t see any of the typical ADHD meds listed.

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Question?: Autistic Spectrum

Susan asks…

What would I have to say to my doc for them to do a cat or mri scan of my brain and have insurance cover it?

I don’t want to be dishonest or anything, but I’ve been having occasional migranes(about one a month and I’ve never had them before until last year). I’d really like them to take a look and see if everything looks normal. Also I have some symptoms that might put me on the “autistic spectrum” so I thought that a scan might give me some comfirmation of that as well. If I told my general care physician that, would that be enough? I have HMO.

admin answers:

Yes. Just go to your GP and describe your symptoms and he’ll do the rest; referring you for the proper tests and all.

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Question?: Ppd Test

Maria asks…

Will testing positive for Tuberculosis make insurance more expensive or difficult to get?

I am wondering if a positive result on a skin PPD test will impact health insurance even if the patient does not develop an active TB infection.

admin answers:

Yes it can. If you have any kind of disease, or test positive for certain things, have high blood pressure or high cholesterol, you can end up paying a lot more for insurance premiums. Many companie will not even insure you.

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Question?: Rett Syndrome Awareness Month

Chris asks…

Would you be more inclined to go to a salon or something if?

they offered a play area for babies/toddlers
Just wondering? I would, Usually I can sneak away to get my nails, hair, whatever done while my husband is home with her, but sometimes it just doesn’t work out b/c of our work hours.
I was thinking it’d be nice if someone would open a salon that had a kiddie corner of some sort so you could relax & get what you need done even with your kids around =)

October is Rett Syndrome Awareness Month! Care today-Cure Tomorrow!

admin answers:

We had a full service salon around here that used have a kids area. It was in an enclosed room with a large window looking into the salon so the kids could see their parents. There was an employee who oversaw the kids to make sure they didn’t get out of control or stray away. They had to charge a bit more because of insurance and the extra employees so the cheaper franchised businesses put them out of business. It was actually a great idea and would probably have done really well in a larger town.

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Question?: Treatment For Autism Spectrum Disorder In Children

Lizzie asks…

Can you have PDD-NOS and not be on the autism spectrum?

Our son has a huge line-up of testing that is scheduled to be done, but the neurologist said that he more than likely has PDD-NOS. Our speech therapist said that PDD isn’t autism, it’s just a delay, is that true? I thought they both go hand in hand.

admin answers:

In short no.

PDD-NOS is on the autism spectrum, it is NOT classic autism, but it is still an ASD- Autism Spectrum Disorder.

Long answer-

Your son might end up with a provisional diagnoses of PDD-NOS- meaning they will diagnose him with that, but then later might drop it. Its very difficult especially at a young age to properly diagnose a child if they have classic autism, or Aspbergers, or a general developmental problem. It can take years for them to know for sure what your son has- but it doesn’t change what type of help he is going to need, however for most state/school programs as well as insurance cases, they need some form of diagnoses to pay for speech/occupational therapy whatever they determine he needs. Because the treatment plan decided on will be individual to your son, it doesn’t really matter what “label” he has as long as he is getting the help he needs.

The name PDD-NOS literally means- Pervasive Developmental Disorder- Not Otherwise Specified, meaning they just don’t have enough data to decided how to specify it. While he has the diagnoses of PDD-NOS he is considered to be on the autism spectrum- however in time they may decided it was a general delay and he won’t be considered on the spectrum anymore.

Right now, my son, has just gone through a bunch of tests, and has a couple more lined up in the fall. He has PDD-NOS, but they feel he will end up being either classic autism or Asbergers, or even OCD (obsessive-compulsive disorder) but right now he shows signs of all three, so they aren’t sure which he has. His neurologist describes it this way- when a plant is very small, sometimes you aren’t sure what type of flower is going to grow on it, however once it blooms it is obvious what kind of plant it was- but it doesn’t change that it is a plant. Meaning my son has something, we aren’t sure what, but it doesn’t change the fact he has something. The main concern is how do you help him get better.

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Question?: What Is Autism

James asks…

Can insurance companies deny coverage for someone because they have a child with Autism?

My son has autism. I am currently employed and have insurance through my work. I am planning on moving and taking a new job but I am worried that I will not be able to get insurance for my son if I move. If anyone knows anything about this please help.

Thanks,

Randy S.

admin answers:

If your current company has over 20 employees (Federal law; some states have lower requirements), the company is required to offer you COBRA. This lasts for 18 months but can be extended for another 18 months for some pre-existing conditions. I don’t know if autism counts.

COBRA costs 102% of the entire premium (employee amount + employer amount + 2% administration fees).

Group health plans, like offered through, employers are not allowed to discriminate for pre-existing conditions. So if you don’t lose coverage for even a day, the new plan will cover you, if you get it through work.

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Question?: Treatment For Autism

Robert asks…

Are there any programs that provide free or low cost treatment for autistic children?

My child may have autism and I work but my insurance does not pay for autism….Treatment is expensive. Are there any programs for low income families or single working mothers?

admin answers:

Yes. It would be helpful to know your location in answering your question, as options will differ across locations, but I will try to give you a general answer.

The programs aren’t even necessarily for low income people but for anybody with an autistic child. There may also be income-specific programs though too. First, let me point out that laws across the USA are gradually being enacted that require health insurance to provide some coverage for autism. You may have legal rights to some coverage and just because the insurance company tells you they don’t cover autism doesn’t mean that that is true. People ARE winning lawsuits against insurance companies to cover autism. Second, you will want to investigate what your state government offers in terms of paying for treatment. I am in California and the state will pay entirely for treatment for eligible kids. Third, all children in the USA are entitled legally to a free and appropriate education (FAPE) and this means addressing autism in the kids who have it. So, at a very early age, if your child needs the treatment, this can be paid for by the school system. If a special education program is not going to be the best option for your child then the school must pay for other treatment, usually in the form of in-home Applied Behavior Analysis therapy.

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Question?: Treatment For Autism In Toddlers

Sharon asks…

My child may have autism. Should I quit work?

I have a professional job. We learned today that our toddler may have autism. We already know she has some developmental delays. My question is, should I save as much money as I can and quit my job in August so that I can be with her next year before she goes to Pre-K? I really want to quit my job now.

admin answers:

I am all for mothers staying home whenever they can. But this may be an exception. Your daughter can recover from autism. But it will take biomedical treatments that are not covered by insurance for the most part, so you will probably need the income from your job to cover the costs.

To find a DAN! (Defeat Autism Now) doctor near you:
http://www.autismwebsite.com/practitioners/us_lc.htm

Main page: http://www.autism.com/index.asp

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Question?: Treatment For Autism

Daniel asks…

What will it take for insurance companies to recognize autism as a neurological condition?

Insurance companies often treat autism as if it was a psychological condition to avoid paying insurance claims. My daughter needed general anesthesia to have a cavity treated by the dentist. The insurance company denied the claim stating: “General Anesthesia is not a treatment for autism“. We appealed the claim and lost… 🙁

admin answers:

This is insurance for you. My son had a bunch done a couple of years ago. Of course he gets medicaid so no problem just jumping through hoops. I would get the dentist on your case with the insurance. Find some proof that it is less stressful with the general. I know it is for the person doing the job. That is why they will more than likely be willing to help you. As far as seeing it as a nuerological condition don’t hold your breath on that one. They still don’t know what causes it, or even why some children with autism can communicate. If you live in a metro or bigger area I would find some local people that have also been through this. Wishing you both best of luck. A….

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Autism and Insurance: Is the law on your side?

Yes, it is! But few parents know this. Autism Advocate Feda Almaliti explains:

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Many families are coping with autism these days. Consider the statistics; one in every 88 children is diagnosed with autism spectrum disorder (ASD). Even more startling, one in every 54 boys has autism. There is a child born every eight seconds in the United States, and according to the US Census Bureau, more of those births will be boys than girls.

“Early intervention is critical,” parents of children with autism are told, “Get intensive therapy as soon as possible! Do you want your child to be able to talk? Use the bathroom? Live independently? Get that therapy… 25, 30, even 40 hours a week.”

But therapy for children with autism is a financial hot potato. Insurance companies have refused to pay for it. Social services agencies play hide-the-pea with confused parents until their children age out of eligibility (which is easy, since it happens at age 3, the average age of diagnosis). School districts then expertly pick up where the agencies leave off, ensuring that only the most determined and litigious parents receive some portion of the therapy their doctors are recommending.

Autism parents are exhausted (mentally, financially and emotionally) by the time their children are six years old. But the marathon isn’t even at the halfway point by then.

In California and around the nation, a massive fight began to change this pattern. Last year, SB 946 (the Autism Health Insurance Mandate Bill) authored by California State Senate President pro Tempore Darrell Steinberg, was signed into law. It takes effect July 1, 2012.

This law states that California’s state regulated health care plans (also known as fully funded or fully insured plans) that provide hospital, medical, or surgical coverage must also provide coverage for “medically necessary” behavioral health treatment for pervasive developmental disorder or autism.

The behavioral health treatment covered by SB946 includes applied behavior analysis (ABA) and other evidence-based behavior intervention programs.

Ring it from a bell tower. Shout it from the rooftops. This is a big deal!

Parents of children with autism who have fully funded insurance now have hope. Autism therapy should be covered through their plan. Regional Centers, the California agencies responsible for serving residents with developmental disabilities, can and should be responsible for the co-payment.

But for parents, getting insurance coverage for this therapy will still be a challenge. It is never easy to get coverage for expensive treatment. This new law paves the way; it doesn’t guarantee easy access.

So it is time to saddle up. The law is on your side. But you need to be prepared to match opposition with persistence, refusal with resubmission, and to be your child’s personal cowboy. Step up.

Insurance companies have perfected some quietly time-tested methods. They know that if virtually 100% of their subscribers whose children receive an ASD diagnosis come to them requesting therapy. if they refuse them all, only about 10% will come back and challenge that refusal.

The rest will go away.

Be the 10%! You will navigate the refusals, the requests for further information, the redirection and the misdirection. You will not be alone as you make this journey.

For specific information on how to begin the process of requesting insurance coverage for autism therapy (and a peek at the obstacles you are likely to encounter) attend an upcoming insurance lecture in your area or visit Check out www.autismhealthinsurance.org or www.autismvotes.org better yet talk to other fellow parents., join an insurance users group Kaiser Members & All other Health Plans

One caveat – this law does not apply to health care plans that do not deliver mental health or behavioral health services to enrollees, or to participants in the Medi-Cal program. While the Healthy Families Program and California Public Employees Retirement System (CalPERS) are explicitly excluded from the law, they are not exempt from the existing Mental Health Parity law (AB 88).

According to a recently published survey by the Autism Society of California, when families were asked,  “Do you plan on accessing benefits through the new autism health care law? “ almost half (44%) answered, “What health care law?”

Now you know! Let’s ride!

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Feda Almaliti, mother of 3, autism parent and health advocate. Feda is one of the foremost authorities on autism and health insurance coverage in California; she was instrumental in the passage of SB 946.

Currently is a trustee on the state Advisory Commission on Special Education, the Insurance Sub-group Co-chair on Bay Area Autism Regional Task-force (BAART) and is also the founder of the Fremont Special Ed pta (SEPTA).

She and her son have also been featured in numerous news stories, most notably ABC and CBS news.

Feda can be contacted at feda@autismadvocates.com

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Got  questions? Need resources? Email me here citybights@sfgate.com and I will do my very best to help.

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FOLLOW ME on FACEBOOK and TWITTER and read the first three chapters of A REGULAR GUY:GROWING UP WITH AUTISM HERE.

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