For families needing the services of Thrive Autism Solutions, this is the best time of year. That’s because open enrollment for insurance that covers its specialized services starts Nov. 1. Parents seeking behavioral treatment for their children diagnosed with autism can access evidence-based interventions offered by Thrive called Applied Behavioral Analysis (ABA). ABA is currently the only behavioral method endorsed by the U.S. Surgeon General, American Academy of Pediatrics and NIH for impacting autism. “We get calls all year round,” says Liz Kinsella, Thrive program director. “Probably about 20 percent have insurance coverage with ABA on it. It’s hard in February to tell people the enrollment window just closed. But during this time of year (Nov. 1 to Jan. 31) you can direct people to the Affordable Care Act Marketplace and get the process started.”
While United Healthcare and Aetna have withdrawn from the 2017 Marketplace nationwide, remaining companies, like Anthem, still offer ABA coverage. If a child is signed up for a Marketplace plan by Dec. 15, the coverage will begin Jan. 1. The enrollment window closes Jan. 31.
Once potential clients have insurance, Thrive Autism has a full-time insurance and billing specialist to verify benefits, secure authorizations and process claims. What complicates matters is that while insurance companies here have to include ABA, employers can opt out of the coverage. “People will call up and say they have United Healthcare, and I will say, ‘That’s great, but let’s look at your plan,’” Kinsella says. “Even in mandate states like Missouri and Illinois, because it’s not federally regulated yet, it’s up to the states and there are ways to get around offering the coverage.”
When Kinsella talks to parents on the phone, she explains that if they send a copy of their insurance card, the office can verify their plan’s benefits. “We try to hold your hand through it,” she says. “You have enough going on; you don’t need to be spending hours making calls. We try to make it as stress-free as possible for clients and educate them on their options.”
For families frustrated because they missed this coverage in the past, Kinsella urges them to try again. Some families will take the child with autism off the family’s insurance plan and get them their own plan in the Marketplace. “Yes, they are paying two premiums and two deductibles, but they’re paying for something that is getting their child the care he or she needs,” Kinsella says.
Recent studies show 1 in every 68 children are diagnosed with autism. That number is higher—1 in every 42—among boys. Kinsella advises parents to seek out a doctor as early as possible if they see signs for concern in their children. Once there is a diagnosis, Thrive is there for the next step – whether that be therapy or simply advice. “Look for quality, evidence-based treatments in ABA,” Kinsella says. “I hate to see parents put their money into alternative therapies that are not evidenced-based. We will provide parents resources on how to advocate to get services their children need.”
Pictured: Program director Liz Kinsella
Photo: Bill Barrett
On the cover: Thrive Autism Solutions offers evidence-based interventions to treat children with autism spectrum disorders. Treatment takes place in the home or at the Olivette clinic. Pictured on the cover: Behavior technician Blair Brown, program director Liz Kinsella and behavior technician Kaylie Elias. For more information, call 314.932.2402 or visit thriveasd.org.
Cover designed by Julie Streiler | Photo: Bill Barrett
