To date, no cure for autism has been discovered. However, this is not to say that nothing can be done. Most health professionals believe that early intervention programs are crucial in the treatment of autism. The treatment options are varied and can include specialized behavioral and educational programs, and complementary and alternative medications. These types of programs can last months, years, or even a lifetime depending on the severity of the disability.
Needless to say, this can become quite expensive. The Harvard School of Public Health published a 2006 study estimating that it costs approximately $3.2 million to care for an individual with autism over his or her lifetime. Furthermore, it is not uncommon for some families to spend in excess of $50,000 per year on autism related therapies, such as applied behavior analysis.
The numbers are clearly staggering. Most individuals or families are unable to bear this type of financial burden without the help of medical insurance providers. Navigating the ins and outs of your family’s medical coverage, however, can be a frustrating process. With the seemingly unending barrage of specific terminology and variations in policies, it can become confusing and overwhelming very quickly, but don’t worry, we are here to help! Below you will find several links to valuable resources pertaining to insurance. It is important that you understand your rights and responsibilities when dealing with your insurance carrier.
Circles BCS is a contracted provider for most Health Alliance and Blue Cross Blue Shield of Illinois insurance plans. However, even if you are covered by either of these companies you should check with them to make sure we are a provider for your specific plan. Coverage is subject to your plan’s benefits and limitations (e.g. co-insurance, deductibles, etc.). Additionally, a prescription from your child’s doctor will be needed stating that applied behavior analysis (ABA) services are medically necessary for your child. ABA services are only required to be covered by insurance companies for those clients under the age of 21 with a medical diagnosis of autism.
Although we are not currently contracted with any other insurance providers we are willing to consider expanding to give you and your family the best care possible. Furthermore, regardless of whether or not we are a contracted provider does not mean that we cannot work with you, nor does it necessarily mean that other insurance companies will not cover any of our fees. If we are not a contracted provider for your insurance company, our payment policies will require you to cover the cost of our services before we provide those services. After payment has been made and the services delivered, we can work with you to help file a claim to your insurance carrier so that you are reimbursed if that is possible with your specific insurance coverage.
It is always a good idea to contact your insurance company to verify that ABA services are covered by your plan and to find out if you have any pre-authorization requirements. Here is some of our information your insurance company may ask for when you call:
Circles BCS Inc. Tax ID: 45-4131352
Circles BCS Inc. NPI: 1467633966
Kim Williamson, BCBA, Director of Circles NPI: 1801067400
CPT Codes we use:
For Health Alliance: 96150 – Assessment, 96155 – Consultation, and 96152 – Therapy
For Blue Cross / Blue Shield: 0359T – Assessment, 0370T – Consultation, 0364T & 0365T – Therapy
Additionally, you may find it useful to look at the following link. It is a brief glossary of insurance terms we have put together that you might find to be a helpful reference if you do not have much experience dealing with medical insurance.
Illinois Insurance Coverage For Autism
In December of 2008, Illinois put a new law into effect, Public Act 95-1005, that requires group health insurance policies and HMO contracts to cover the diagnosis and treatment of autism spectrum disorders for individuals under the age of 21. The maximum coverage required by law was up to $36,000 per year in 2008, and typically increases on an annual basis—in 2012 it increased to $39,721. It is important to note that not all insurance policies are subject to this law. To learn more about this law and who it covers, see the following link.
Illinois Insurance Coverage FAQ
If you have any additional questions about what exactly Public Act 95 is, who it covers, or what it requires from insurers, the following link answers many frequently asked questions.
Autism Insurance Laws Throughout the U.S.
Illinois, of course, is not the only state to have enforced laws for insurance providers regarding autism. In fact, many other states have very similar laws. Some states, however, have no laws concerning insurance coverage for autism. Below you will find a link to a page that details autism insurance laws for each and every state.