Autism and Washington State Insurance Updates

Autism & Washington State Insurance Updates

With the roll-out of the Affordable Care Act, health care coverage has become even more complicated that it was before – and it was really complicated before! Although more children and families have access to health care coverage, there remain barriers in the system – particularly due to some plans with limited networks. Kathy Brewer, MS, LMHC, Psychiatry Insurance Processing Manager at Seattle Children’s shares valuable updates about Washington State insurance changes.

What are some of the changes?

• Federal parity laws were implemented that require most (but not all) plans to cover mental health services at the same level as medical. This means the copay, co-insurance and deductibles are the same. This doesn’t mean the network is the same. And some plans continue to put restrictions on covering specific psychiatric diagnoses.
• Also in October of 2015, the United States switched to using ICD-10 which has updated medical and mental health diagnosis codes with more specificity. Most insurance plans have converted to accepting ICD-10 codes with few problems seen so far.
• More commercial insurance and now Washington Medicaid is providing an Applied Behavior Analysis (ABA) benefit for children with Autism Spectrum Disorders. Although there are waitlists at most agencies, the number of agencies are increasing and the ABA benefit is allowing more children to receive this helpful service.

At the Seattle Children’s Autism Center, we continue to have medical providers such as pediatric nurse practitioners, neurodevelopmental pediatricians, neurologists, and speech and language pathologist whose services fall under the medical benefit and medical network.

And we have psychiatrists, psychologists, psychiatric nurse practitioners, and behavioral consultants whose services fall under the mental health benefit and mental health network. It can be confusing and frustrating for families to not always be able to get equal coverage or access to all of our services because of these insurance limitations.

We are updating our last insurance blog from 2012 with some current answers and tips for families.

If your child is a patient at Seattle Children’s Hospital we encourage you to view Billing and Insurance: Frequently Asked Questions.

If your child is receiving mental health services (which includes various therapies and medication management) at Seattle Children’s Hospital, we encourage you to view Seattle Children’s Insurance Coverage for Mental Health Services.

If you are wondering whether your insurance plan will cover mental health services at the Autism Center, please view the Seattle Children’s Mental Health Insurance page which lists those plans that do not contract with us for mental health care. If your insurance plan is not on this list, then most likely it will cover care with us.

If your child has Washington Medicaid please visit the Washington State Department of Social and Health Services page to learn more about mental health services available to your child.  You can visit the ABA Services page to learn more about the Medicaid ABA benefit.

While the resources above are specific to Washington and Seattle Children’s Hospital, there are some things we can recommend that may apply more generally:

• Always call your own insurance company to find out your benefits. Usually, this number can be found on the back of your benefit card, listed as “customer service”.
• Medical benefits and Mental Health benefits are different! Ask your customer service representative, ”What are my mental health benefits?”
• Cost can vary significantly between “in-network” and “out-of-network” providers. Although some providers may know if they are “in-network” with your insurance, you should always verify this yourself.
• Before making a change in insurance – check to make sure your current providers or providers you would like to be able to see – are in the new plan’s “network”.