A new bill in the Virginia General Assembly may help parents with autistic children. House Bill 83 would require insurance providers to cover costs associated with treating autism. The cap for treatments has been set at $36,000 per year.

According to the Autism Society, the cost for medically treating an autistic child could cost a family $5 million over the course of a child’s lifetime. Each year, parents pay thousands for therapy and other medical necessities which may not be covered by insurance. However, insurance companies have pointed out that if they are required to cover such costs, it will probably mean raising insurance premiums.

As a parent of two autistic children, I am following this whole situation to see what actually comes of it all. I understand that other states, like Pennsylvania and South Carolina, have passed similar legislation aimed at providing financial relief for parents of autistic children. I wonder if this legislation has impacted families in these states in a positive or negative way. I also wonder about other parents who have children with other serious health conditions which have been financially devastating to them and shouldn’t they also be legally entitled to some sort of financial relief if such relief is given to parents of autistic children?

I’ve lost track of how much money our family has spent out of pocket dealing with the multiple issues that have challenged my children. I have to admit that I’ve not even seriously looked into some courses of therapy simply because I knew that we could never afford them. Because of this fact, I’ve spent a lot of time researching and trying to implement some of the successful therapy strategies into our daily lives. I’ve seen a lot of progress in my children over the years, but it’s been exhausting for me!

If passed, this legislation could change our lives radically. I’d like to believe that it would change our lives would for the better, but I am cautious. Would there be a number of bureaucratic ‘hurdles’ to deal with or would it be relatively painless to reap the benefits of this new legislation? I also wonder if there couldn’t be another way to help parents of special needs children cover some of their out of pocket medical expenses. There are a lot of issues and concerns to think about and the answers don’t seem to be very easy; at least from my perspective.

Does your state have a plan which covers autistic medical treatments? Do you support such legislation?

When you first find out you’re pregnant, your thoughts may immediately go to picking nursery decorations and the imminent labor pains. But you should also be focused on how your health insurance is going to affect your pregnancy. Having a child is one of the times in your life when your health insurance will become very important. From my experience as a medical biller, I’m going to share with you the top ways to get the most out of your insurance while you are pregnant.

This article gears more towards patients with insurance. For those of you that do not have insurance, call your local State Human Resource Department. ANYONE can file. It doesn’t mean you will always be accepted but filing is the only way to find out. Even if you have insurance but your coverage is low and your finances are high, you may be accepted for state help.

So onto the checklist:

1. Call your insurance company to confirm your doctors and hospital are listed as an ‘in-network provider.’ An in-network provider is paid at the highest percentage with a low allowance. What this means is the lowest cost for you. If you haven’t picked out a doctor yet, your insurance company can help you find one.
2. DON’T PAY anything upfront unless it is a co-pay for a doctor’s visits. Pay after your insurance company processes a claim/bill. The insurance company will send a check to the doctors and hospital. You will receive a letter explaining what was billed and paid for each visit or service. This form is called an ?Explanation of Benefits.? It also explains the approved price to the doctor or hospital for payment. (Example: The hospital bills $2000 for an ultrasound but your insurance company only approves $1000.00. Your insurance company pays *80% and you are billed the *20% of $1000.00; not the $2000 originally billed by the hospital.
   *Percentage paid varies on your individual or company plan.
3. Make sure all treatment and visits are APPROVED. Most contracted ‘in-network’ providers are responsible for approving your treatment or what is called a Prior Authorization. It is permission granted by the insurance company to your healthcare provider to perform his treatment. I have witnessed patients charged because the doctor or hospital didn’t get your services approved. You can always make sure this is completed by calling your insurance company.
4. Use what’s available to you. Most insurance companies now have a special unit for any pregnant patient in the Prior Authorization Department. They also assign a Case Manager or Nurse Unit that oversees ALL your care. Get to know them! Obtain the direct number and make sure they are up-to-date on any procedures or visits.
5. Keep track of everything! File all your bills, receipts, explanation of benefits and letters received by any of those mentioned above. Combine them according to the date of service and keep them handy. Take notes of every conversation including who you spoke to on what day. All of this may prevent you from being billed inappropriately. Make sure you only pay what your Explanation of Benefits shows under ‘patient portion’. And last but not least, don’t pay until you receive both a bill from the doctor/hospital AND the Explanation of Benefits.

This is not only a checklist to follow your healthcare needs during and after your pregnancy but it is a guide to follow for any healthcare procedure you may undergo in the future. Feel free to comment any additional questions or insurance horror stories you may have and I will see what I can do to help.

Written by: Kelli Swift

]]> http://blogs.babiesonline.com/pregnancy/kellia-pregnant-womans-guide-to-health-insurance/feed/ 0 http://blogs.babiesonline.com/baby/get-a-free-child-safety-id-kitfrom-gerber/ http://blogs.babiesonline.com/baby/get-a-free-child-safety-id-kitfrom-gerber/#comments Mon, 21 Apr 2008 22:07:50 +0000 Dan http://blogs.babiesonline.com/?p=2461

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My husband’s work insurance is changing, and if there’s anything less fun than floundering in an alphabet soup of HMOs, PPO and PCPs, it’s finding out that our pediatrician isn’t on the list of providers. After a minor panic attack (seriously, we love our doc) and a morning spent on the phone with the insurance company and the doctor’s office, the problem seems to be solved. (Although with insurance you never know.) But the close call got me to thinking about what I’d do if I had to look for a new pediatrician, and I came up with four W’s that I’ve used as a guide in the past:

WEB SITE

When researching new doctors, their Web site can give you a good idea what their practice is like. Our doctor’s site is super helpful: bios on all the doctors, nurse practitioners and staffers; patient forms that can be printed out in advance of visits; numbers and office hours; and news on recalls and other health issues. There’s even a monthly e-newsletter. The thorough, informative site gave me a good first impression of the practice.

WORD OF MOUTH

Of course, there’s only so much you can glean from the computer. References and the opinions of friends can clue you in to what the doctor’s office is really like. Are calls returned promptly? Do staff and doctors take time with each patient, or rush them through appointments? Is there a good selection of toys in the waiting room to distract little ones (and are those distractions necessary because it takes forever to get called back to an exam room)?

WORKING RELATIONSHIP

But even if all your friends rave about a pediatrician, it doesn’t necessarily mean she’s the one for you. Our first doctor was recommended by a friend, and while she was nice enough, the care was just … kind of blah. In fact, it was so hard to get an appointment with her that about half the time we saw someone else in the practice instead. Your pediatrician is your partner in taking the best care possible of your little one, and you need someone you feel comfortable with. Can you ask questions and not feel patronized or rushed along? Does the doctor listen to your concerns? Do they show respect and kindness when talking to your child?

WELL BEING

In the end, we chose our doctor because we believed we could entrust her with our children’s health and well being. She puts a premium on preventive care, and ensures that kids get proper exercise and nutrition. She (and every doctor in the practice) calls the day after appointments to follow up and see how the kids are doing. And when I left a phone message today to talk about our insurance dilemma, she called back literally within five minutes. And when she told me she could still be our doctor, it was another W: wonderful.

What do you look for in a pediatrician? if you have a good one, what do you like about them? And if you’ve had a bad experience, what has that taught you?