Autism & Insurance Coverage & Preexisting Conditions

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Hi All,

We are heart broken and broke into tears when my child of age 1 Year 10 Months got diagnoised with Autism. We need some help in terms of Insurance Plans for our Kid. Actually at the time of Birth and till he is 6 Months old we have Insurance coverage for my Kid. After Six Months my Wife and Kid went to India for 1 Year and 3 Months and my Employer discontinued the Insurance as they are outside of the Country. Which makes Sense. But when I asked the present Insurance Company to add my Kid and Wife to my Health insurance they said it is ok to add, but there is clause that states, prexisting conditions are not covered for 1 Year. Will Autism be treated as Pre Existing Condition. The diagnoises is done in India but not in USA. Here may be Doctors need to do lot of Screening to decide wether it is Autism or Something else.

How to tackle this situation and How can I have my kid covered for Insurance. I live in NJ and my Kid is Citizen of USA. I wanted to go for all the possibilities of Insurance to ensure that my kid gets a better treatment with Intensive Therapies. So that he can mould at this age.
I know there is a plan called NJFamilyCare but will it give adequate coverage for my kid who needs Special Therapies like occupoational, SPeech Therapy etc ?

Your replies will be much appreciated in these toughest situations

Thanks,
Sana

I believe that it is illegal for them to apply the pre-existing condition clause to a child. However, that is just my understanding based on the insurance information I have recently dealt with. If it is somehow possible for them to apply that condition though, your state care that you mentioned should cover therapies for autism and likely would not try to impose a time period before coverage would kick in. In general, the medical profession has recognized the importance of early intervention for autistic kids. I recently changed jobs and the new health ins. coverage has a clause specifically referring to coverage for autism therapies.

Also, check what services and monies are available from the State. Your caseworker may also be able to help you figure out the insurance situation.

Remember that the Health Care act has several provisions, like restrictions on pre-existing conditions, phasing in. So the rules you got, for example, a year ago will not neesarilly be the rules when the child actually comes on the policy.

There are a lot variables that come into play with insurance. I'm in PA and my child is not covered for any autism-related services or therapies even though my state passed a law requiring insurance companies to cover autism services. It seems that state-run plans are exempt (my child's on CHIP - my employer does not offer healthcare benefits) and so are certain established plans that are "grandfathered." Basically, if insurance companies can find a way to exclude services, then that's exactly what they'll do.

The good news is that you should be able to get services through the school district via Early Intervention. I'd recommend starting here: http://www.njeis.org/
These services should be of no cost to you and your family and they are not dependent on an official diagnosis. Services are determined by an initial, independent evaluation paid for by the state.