Autism Insurance Resource Center releases new tool to help families determine insurance coverage

May 12, 2015

Am I Covered,” a tool to help families determine whether their health insurance policy covers services under the Massachusetts Autism Insurance Law, has been launched by UMass Medical School’s Autism Insurance Resource Center.

“The tool was conceived of in response to lots of questions from the autism community on where to start with figuring out if their insurance is covered by the Massachusetts Autism Insurance Law,” said Amy K. Weinstock, founding director of the resource center at UMass Medical School’s Eunice Kennedy Shriver Center and the parent of a young adult on the autism spectrum. “Insurance is complex and confusing. This was a tool to help families as well as providers.”

An Act Relative to Insurance Coverage for Autism (ARICA), also known as the Massachusetts Autism Insurance Law, requires health insurers in Massachusetts to provide coverage for the diagnosis and treatment of children and adults on the autism spectrum, which affects one in every 68 individuals. Insurance plans that aren’t subject to Massachusetts law may not cover autism treatments. The tool, which was designed to be used by consumers and health care providers, is the only resource of its kind available only for Massachusetts residents.

The tool was developed by the technical team at INDEX, the Shriver Center’s Disability Informatics Resource, with funding from the Massachusetts Department of Public Health. The INDEX team spent 18 months developing the tool and testing it with consumers and health care providers before it was released.

“The feedback from the consumers and providers who tested the tool has been universally positive,” Weinstock said.

The major influencers for the site were providers and families in Massachusetts who experienced challenges with trying to find out if their insurance was subject to ARICA, said Derek Chaves, director of technology at INDEX.

“When a parent or caregiver receives news of a diagnosis it can be overwhelming. It is important that they understand that one of the first steps is to understand their insurance coverage and how the ARICA mandate applies. Parents and caregivers can use the ‘Am I Covered’ tool to streamline the first step of the process and go down a path that ultimately leads to the child receiving the care they need,” Chaves said.

Massachusetts law only affects some types of health care policies. Users employing the tool can quickly identify whether their policy includes ARICA’s mandated coverage. Plans that aren’t subject to ARICA may cover some treatments, but not others. If autism treatments aren’t covered by a family’s insurance policy, they may be able to obtain additional coverage. Information about obtaining additional insurance coverage is outlined on the tool, and the resource center can provide additional information and technical assistance.

The Autism Insurance Resource Center at the Shriver Center, a unit within UMass Medical School’s Commonwealth Medicine division, was founded in March 2011 after a state law was passed that requires private insurance coverage of medically necessary autism treatment.

In addition to assisting families and caregivers in accessing and using the right health insurance to meet the needs of children and adults on the autism spectrum, the resource center provides assistance to providers, employers and educators on a broad range of issues related to medical insurance for autism treatment.

To access the tool, go to its website.                                                   

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