With the deadline for open enrollment in the Washington Health Benefits Exchange quickly approaching on January 31, 2016, Melissa Hopkins is sharing her story of how this program has changed her son Gavin’s treatment for the better, and how WAAA assisted her in exploring her options.
Melissa first noticed that her son, Gavin, might have developmental issues right after his first birthday. He stopped responding to his name, and did not smile, clap his hands, or waive. He started spending all of his time playing with cars by himself and stopped saying all words, including momma and dada. He was officially diagnosed with autism around 18 months of age.
“I have turned into a crazy mom, doing everything I can to make sure he gets the help he needs,” Melissa says. “The two month wait to see a pediatric neurologist was frustrating and difficult. The two month wait to have ADOS assessment was also frustrating, though I have heard many have had to wait much longer.” It was a struggle to know where to start and who to contact to get the help Gavin and his family needed, but Arzu and her staff at WAAA were a great help.
“Trish and Mira at WAAA have been helping me appeal our current health insurance exclusion of Autism benefits,” Melissa relates. “One of them told me that one option was to buy a policy on the exchange, since all policies on the exchange have to cover ABA therapy.”
Melissa’s experience navigating the Benefit Exchange program has been mostly positive. It is “a very user-friendly website. It was fairly easy to log in and get estimates and information about the different policies available. Since we don’t qualify for a subsidy, I called the insurance companies directly to get more information and am buying a policy through them. The Washington Health Benefits Exchange helped me get all the basic information and prices.”
“The Exchange has given us hope to get Gavin the ABA therapy and help he needs. Without the Exchange, this would not have been possible financially.” Melissa and her husband were considering career transitions to assist with insurance coverage, but this would not have been ideal for either of them. Instead, Melissa says, “The Exchange solved all our problems…I would recommend anyone planning to buy a policy on the Exchange dig into the details of the policy.” ABA therapy for Gavin will be starting in January of 2016, thanks to the information and support received from WAAA and the Exchange.
Purchasing an individual or family plan through the Washington Health Plan Finder or directly from an insurance company can allow an individual with ASD to access timely treatment they might not otherwise be able to access and reduce the significant financial strain placed on families whose insurance plans have exclusions.
In October 2014, the Washington Supreme Court ruled unanimously in O.S.T. v Regence that blanket or categorical exclusions for medically necessary mental health services violate both state and federal Mental Health Parity laws.
To find out if a purchasing a plan is financially viable a family can use the Individual and Family Cost Calculator. All plans should have autism coverage but some have varying visit limitations. The family can obtain help exploring and purchasing a plan with an insurance navigator or can contact WAAA for assistance.