I’m really new to navigating insurance for my child who has just received a diagnosis. Where should I start?
Starting the process of navigating medical treatment and insurance can be really scary and confusing.
- You might start with the diagnostic report. The doctor will usually have made recommendations for treatment, classes for you and other resources to get you started.
- We’ve put together some Insurance Tips that may be helpful.
- Give us a call! We’re happy to help with the first steps (and the hundreth step!)
I’ve heard about a lot of assistance programs but I’m not sure which ones to apply for. Where can I find more information?
You can find more information in this Washington Assistance Programs resource page.
I have Medicaid/Apple Health and I keep hearing the term “Managed Care Plan”. What is a Managed Care Plan?
The state’s Apple Health/Medicaid program contracts with five private insurance plans to administer Medicaid/Apple Health benefits. These are: Amerigroup, Coordinated Care Corporation, Molina Healthcare of Washington, UnitedHealthcare Community Plan and Community Health Plan of Washington.
Can I change my Managed Care Plan?
Yes, you can change your Managed Care Plan anytime you wish to. The change becomes in effect the month following the change. More information can be found here.
I’m not sure which provider is best for my child. How can I get started finding one?
Visit our How to find and choose a provider resource page for information on locating and choosing a provider.
Can I have Private Insurance and Medicaid Insurance?
Yes, you can have both. If you do have both you can apply for the Premium Payment Program (PPP).
I have Medicaid for my child. Should I put him/her on my or my spouse’s employer sponsored private insurance plan?
Yes, private insurance is accepted by more providers than Medicaid. Having private insurance can sometimes drastically lessen the wait time for services. If your child becomes no longer eligible (due to income or other factors) for Medicaid having Private insurance already established can be helpful and reduce unnecessary gaps in services.
What does the Premium Payment Program cover?
If I purchase a plan through the Washington Health Benefit Exchange, Washington Healthplanfinder or directly from an insurance company can I still qualify for the PPP?
It depends:
Plans purchased through the Washington Health Benefit Exchange or the Washington Healthplanfinder receiving Premium Tax Credits are not eligible for the PPP.
If you are not eligible for the Premium Tax Credit (due to income or other circumstances) you may be eligible for the PPP.
You will need to provide proof of:
- Who the policy covers (the PPP will only cover the Apple Health/Medicaid recipients portion).
- That you did not receive the subsidy.
My child qualifies for Medicaid through a Developmental Disabilities Administration Waiver. The rest of our family does not qualify for Medicaid. Can my child qualify for the PPP?
Yes, your child may still qualify.
If I have private insurance from my employer and Medicaid can I qualify for the PPP?
Possibly. The Plan will need to be considered cost effective and comprehensive.
Can I qualify for the PPP if I have Tricare, Champus or Veterans affairs (VA) Insurance?
No these plans are federally subsidized and are ineligible for the PPP.
Are there limits on the type of deductible I can have to apply for the PPP?
Yes, the PPP will not cover High Deductible Plans, which includes anything over 2250 for an individual plan or 4500 for a family plan.
I’ve heard that I shouldn’t get on waiting lists for treatment because they are too long and this is a waste of time. Is this true?
No. There is nothing to be gained by not getting on waitlists and it is possible to get a provider! When an insurance company does not have any providers that can begin services for your child within a reasonable amount of time (typically defined as 30 days) you can see if there is an out of network provider willing to provide services and apply for an out of network waiver. Check out our Out of Network Waiver/ Single Case Agreement page. For families with Medicaid please visit the Medicaid ABA page.
What treatment should my insurance cover my child with Autism and Developmental Disability (ASD/DD)?
Your insurance company should cover therapies and services that are evidence- based and prescribed by a qualified medical provider. These might include periodic screening, assessment and diagnosis of a suspected developmental disability, Speech Therapy, Occupational Therapy, Physical Therapy, Cognitive Behavioral Therapy (or other behavioral and/or mental health treatment), Feeding Therapy and Applied Behavioral Analysis. More information can be found here.
My insurance company doesn’t cover therapy that has been prescribed by my child’s doctor. What can I do?
If treatment is denied or visits are limited/capped we recommend working with WAAA to appeal and/or petitioning the employer to add benefits.
If I file an appeal with my insurance company will this affect my employment?
If treatment is denied or visits are limited/capped we recommend working with WAAA to appeal and/or petitioning the employer to add benefits.
I have received conflicting information about what is covered by my/our insurance company. What should I do to confirm coverage?
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