Adult autism test covered by insurance?

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Sunnyboy2
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04 May 2015, 1:50 pm

I just got off the phone (after days of fighting myself about calling or not..) with my health insurance provider, and the stated they had reason to believe that an adult test is covered (no idea why, I had heard that its incredibly unlikely).

But if it comes back positive, any autism related therapy won't be covered?
As those services are for children ten years and younger (which I understand, I think).

But they wouldn't bar me from getting mental health help, basically stating if I went to a therapist for depression I would be covered. But I'm wondering if I am confirmed positive for ASD, and I go to a therapist or a psychologist.. and they know I have autism and they state 'depression related to autism', will my insurance cover it?

Anyone have any experience with ObamaCare/Local Marketplace insurance providers at all? I'm wondering if they all do this or not.



starkid
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04 May 2015, 1:58 pm

I have Medi-Cal under ObamaCare and diagnosis is covered as long as you find a provider in your network (try a major hospital). If you can't find a specialist, you can call the insurance provider's customer service number and ask for help finding one.

I also found a graduate school of clinical psychology that will bill insurance and charge on a sliding scale if you are poor enough, regardless of the insurance you have. Others might be the same.


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Sunnyboy2
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04 May 2015, 2:42 pm

The testing is not covered if I test positive (which is really stupid? Don't you think they'd cover for a positive test compared to a negative test), since I am not under ten years old.

And they don't keep a list of providers that may or may not be covered and have experience with ASD adults..

So I guess I will need to look elsewhere. There aren't many resources for people in my state..



starkid
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04 May 2015, 3:10 pm

Sunnyboy2 wrote:
And they don't keep a list of providers that may or may not be covered and have experience with ASD adults..


But they have some sort of list of providers, don't they? You can call the providers to find out if they have the expertise you require.


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Sunnyboy2
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04 May 2015, 3:19 pm

starkid wrote:
Sunnyboy2 wrote:
And they don't keep a list of providers that may or may not be covered and have experience with ASD adults..


But they have some sort of list of providers, don't they? You can call the providers to find out if they have the expertise you require.


They do, it would require me to call a considerable number of providers.
Which I guess I will have to do.



LupaLuna
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04 May 2015, 3:27 pm

My biggest concern would be. Will my insurance premiums go up of I test positive for autism.



Sunnyboy2
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04 May 2015, 3:47 pm

LupaLuna wrote:
My biggest concern would be. Will my insurance premiums go up of I test positive for autism.


That's.. a very valid question.

I imagine it shouldn't because.. well. Smokers smoke because they want to. Are we saying an autistic person is choosing to be autistic? It'd be like upping insurance costs on someone that ends up developing cancer..

But from what I understand insurance companies are no longer allowed to decline people for pre-existing conditions, but it certainly doesn't say a single thing about upping costs on people that are diagnosed or do get diagnosed for health issues, regardless of what they are? Or does it?



LupaLuna
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04 May 2015, 3:54 pm

Sunnyboy2 wrote:
But from what I understand insurance companies are no longer allowed to decline people for pre-existing conditions, but it certainly doesn't say a single thing about upping costs on people that are diagnosed or do get diagnosed for health issues, regardless of what they are? Or does it?


That is a good question? I know that ObamaCare prohibits insurance companies from denying coverage. But I am not aware of anything that says that they can't raise premiums.



Sunnyboy2
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04 May 2015, 4:02 pm

LupaLuna wrote:
That is a good question? I know that ObamaCare prohibits insurance companies from denying coverage. But I am not aware of anything that says that they can't raise premiums.


I think they're trying to not take away all the power from insurance companies, which sort of.. sucks for the people.. But they're companies, they work a certain way. But I suppose you could claim discrimination, as its not something that could be otherwise stopped? Or make you stop doing? Like smoking..

I just know my insurance doesn't provide any services related to autism unless you are under the age of ten. It's like they expect children ten and older to stop being autistic? Seems stupid on their part.



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04 May 2015, 4:36 pm

Sunnyboy2 wrote:
I just know my insurance doesn't provide any services related to autism unless you are under the age of ten. It's like they expect children ten and older to stop being autistic? Seems stupid on their part.


My psychiatrist initially said that my insurance company (Kaiser Permanente) only covered testing and treatment for children, after initially saying that testing and treatment didn't exist for adults at all. I did a bunch of research, talked to a couple of people here who had my insurance, actually found some instances of testing and therapists within my network, and confronted her with that. She did some research (I think she was speaking from ignorance initially) and referred me to a clinical psychologist for testing. I'm waiting for the results now.

They should not be able to deny you coverage because of your age. It violates something called "healthcare parity" which means, that if an insurance company provides treatment for one age, they have to provide it for all ages, and can't put other limitations like numbers of visits. This sounds great, although the reality is a lot more complicated and depends on your state. Some require parity only for "biologically-based mental illness", which i suppose you could make a case for autism, in light of recent brain imaging studies. Parity has not been completely tested in court, so this may mean some research. Be patient! Persevere!! And be polite but determined and firm. It took me six months to get tested (partly because of waiting for the psychiatrist to get back from vacation, and a waiting list to get tested). But now i've got tested, and just need to wait for results. :)

Forgot to add link to NAMI's info on parity: http://www2.nami.org/Template.cfm?Secti ... tID=165381


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04 May 2015, 7:25 pm

The insurgence I had pre Obama Care did not cover testing. I had to pay full for my diagnosis meaning the treatment I can now afford is Wrong Planet

The policy I have now covers ABA and Communication Devices not assessment/testing for any age. From what I gather coverage for adult testing is a rarity in the USA, maybe a few "Cadillac Plans" here or there cover that. Some Universities do give assessments for free for the purposes of study. But once you are over a certain age (45 or so) they are often not interested in studying you.


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04 May 2015, 9:44 pm

Our insurance will cover 18 and under. If you are an adult, who had no special supports at school (IEP or 504), you are f****d. The reason is if you have passed for so long, why is it a red hot now? Also, they will not cover OT, PT, or speech specifically for an Aspie type person who has had no support up until now.

Actually there are no providers that work with very high functioning adults other than mental health. My husband could use pragmatic and receptive language help. His fine motor skills are s**t (always have been), and he has problems with knowing where his limbs are in relation to his body. Can't remember the clinical word for it. Even if we wanted to pay out of pocket, no one will take him. And we live in a fairly big metro area.

We paid for the testing ourselves ($2K), and found the best clinician who gives a bullet proof diagnosis. He did the gold standard testing for adult Autism.

Pick your providers carefully. I came across many how could diagnosis adults by "talking to them". This is bullshit, and they are stealing money.



starkid
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04 May 2015, 10:13 pm

Tawaki wrote:
We paid for the testing ourselves ($2K), and found the best clinician who gives a bullet proof diagnosis. He did the gold standard testing for adult Autism.

What does the gold standard testing consist of?

Quote:
Pick your providers carefully. I came across many how could diagnosis adults by "talking to them". This is bullshit, and they are stealing money.

lol. I don't trust those "talking assessments" either. I found a psychologist like that and asked him if he needed some information from my childhood. He didn't seem to care about it at all. I'm glad I didn't go to him, and got some proper neuropsychological tests along with an interview instead.


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Tawaki
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05 May 2015, 2:52 pm

I don't have my husband's test results, and I'm tripping on Benadryl (allergies).

I had to fill out a form with questions regarding my husband's behavior.
His mother filled out a form in regards from birth to 18. I knew my husband from 21 years old onward.

It's a specific form. I can't remember the name.

He had an IQ test.

He had neuropysch testing done.

I believe there were two other specific tests for adult Autism done. I know someone here knows that they are.

His evaluation took two (3 hours long each) office visits.

I had one doctor who told me he could diagnosis Aspergers in one visit. Loon.

We had all the testing done be a use we were looking at legal action with his employment. We needed hard data, not just guessing.

Sorry I couldn't be more useful.



RhodyStruggle
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05 May 2015, 4:08 pm

I was able to get autism testing done as an adult for free by participating in a study. They gave me the ADOS-2 Module 4, the SRS-2, and the VABS-2. Here's a link to the study for anyone interested, although you have to live in Rhode Island to participate - http://www.brown.edu/research/projects/ ... ment/about

The results that they gave me were stamped "For Research Purposes Only." But they did refer me to an autism specialist who could "interpret" the test results and interview me and then provide me with an official diagnosis. It took a while, as I had the testing done at the beginning of last December and I only just received the documentation of my diagnosis in yesterday's mail.


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