Clarifi - Early diagnosis means early intervention

Is Autism Testing Covered by Insurance?

Sep 23rd, 2018

Although autism prevalence has risen to one in 59 children in the United States, many parents are still unaware of what signs of autism may actually look like in a child. Or, if developmental delay is recognized, it's unclear what the next steps for autism evaluation should be. The Centers for Disease Control and Prevention (CDC) recommends having your child screened for developmental delay as a regular procedure at your nine, 18, and 24 month check-ups. However, a recent study published in JAMA Pediatrics claims that only 37% of children received a developmental surveillance from their healthcare professional in the past year. Even less, only 30% were reported to have received a developmental screening by a parent.

The first step to autism evaluation can be simply and routinely performed by your pediatrician at your child's regular check-up. At your next appointment, ask your pediatrician to perform routine screening for developmental delay. They may ask you questions or talk and play with your child to see how they learn, speak, behave and move. If your pediatrician suspects developmental delay, they will move onto a comprehensive autism spectrum test that could involve referring you and your child to a developmental specialist for a more thorough diagnosis. Typically, these visits for autism evaluation are covered by insurance, but it's always safest to check what's covered on your personal plan.

My child has an autism diagnosis- will insurance help me?

After a diagnosis, the insurance protocols for autism gets a little more fluctuant.

According to Autism Speaks, a program called Early Periodic Screening Diagnostic and Treatment (EDST) claims that any Medicaid-eligible child under 21 "is entitled to all health care services that are found to be medically necessary to treat conditions discovered in the child." This was inducted to help families working to secure Medicaid payment for ABA services.

What are ABA services?

Over the past decade, applied behavior analysis (ABA) has become one of the most popular and well-accepted forms of intervention treatment for autism. Consequently state legislators throughout the country have moved to classify ABA as a medically necessary form of therapy, ensuring its coverage on insurances throughout the states. Currently, 49 states in the United States have laws ensuring some form of autism coverage in health insurance. The degree to what is covered varies depending on state. You can read about the insurance coverage in your state here.

If you're in need of more coverage or are having a hard time navigating the world of health insurance, Autism Speaks has put together a list of laws and links to help you get as much help as possible.