Mira Posner, WAAA's staff Attorney, offers some answers to frequently asked questions about accessing Autism insurance benefits.

Q. Why is plan funding important in an appeal for Autism benefits?

How your plan is funded determines which Mental Health Parity law you will use in an appeal. Plan funding can also help you to interpret current legal proceedings that may apply to your insurance plan.

Q. What is Mental Health Parity & what does it mean for Autism insurance appeals?

Mental Health Parity Laws, both state and federal, require that insurance plans that offer mental health benefits must provide mental health coverage that is at parity with (equal to) the medical/surgical coverage. This means that any financial requirements or treatment limitations applicable to mental health benefits shall not be more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits under the plan.

Mental Health Parity Laws apply to mental disorders covered by the diagnostic categories in the Diagnostic Statistical Manual (DSM) under Mental Health. Autism and Autism Spectrum Disorder are covered by the DSM. Therefore, all evidence based medically necessary therapies for the treatment of Autism and ASD should be covered at parity with medical/surgical treatments, including any co-pays or visit limits.

Q. What are the Mental Health Parity Laws?

In Washington State, there are two Mental Health Parity laws you should know about:

The Paul Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). (View the law here, )

The Washington State Mental Health Parity Law. (View the bill here. See also RCW 41.05.600; 48.44.341; 48.46.291)

Q. Which Mental Health Parity Law applies to my plan?

It depends on the type of plan you are enrolled in. You can learn more about types of plans and which laws apply on the WAAA Members website.

Q. How can I find out what type of plan I have?

To find out if your health insurance plan is self-funded or fully insured you can email or send a letter to the Human Resources or Benefits Department at your employer and ask “Is my ------- health insurance policy self-funded or fully insured?”

You can also look for this information on your Plan Document/ Certificate of Coverage also called the Evidence of Coverage. For instructions on how to obtain a copy visit WAAA’s Private Insurance Appeals page.

Q. Who can I contact for help with my Autism Insurance benefits?

You can contact a WAAA Advocate for free Autism Insurance help.