Michigan Autism Insurance
Autism Insurance Legislation
Michigan's Autism Insurance Reform legislation (PA 99 and PA 100 of 2012) went into effect on October 15, 2012. For-profit, commercial, HMO, and non-profit health insurance companies regulated by the state of Michigan are mandated to provide an autism benefit to its insured members covering services related to the diagnosis and treatment of autism spectrum disorders (ASD) through 18 years of age.
Self-funded insurance plans are regulated by Employee Retirement Income Security Act commonly referred to as ERISA through federal law. Self-funded insurance plans are not mandated to provide autism coverage. However, if a self-insured company self-adopts an autism benefit whereby employees are offered autism coverage by the self-insured plan, then the self-insured company either directly or through its third party administrator (TPA) may submit reimbursement request(s) to cover the cost of the paid claims to the Autism Coverage Fund.
The Autism Coverage Fund was created to offset the cost of providing an autism benefit for health insurers, TPAs and self-insured companies. To participate in the Fund, paid claims must be for insured members who are residents of Michigan and who receive an ASD diagnosis and treatment by Michigan providers.
Medicaid & MIChild Autism Benefit
The Michigan Medicaid and MIChild Autism Benefit went into effect on April 1, 2013.This Autism Benefit provides children ages 18 months through 18 years old who have a medical diagnosis of Autism Spectrum Disorder (ASD) with Applied Behavior Analysis (ABA) services.ABA is a recommended service for children with Autism Spectrum Disorder. It has been researched for over 30 years and endorsed by the Surgeon General. ABA treatment can be used to address skills and behaviors relevant to children with Autism Spectrum Disorder.
Insurance Verification & Billing
You must provide proof of insurance prior to your first visit. ACM works with and bills your insurance as a courtesy to you. Our intake staff will verify benefits and discuss with you, your coverage benefits and expectations for payment of deductibles, co-payment and co-insurance costs. It is your responsibility to know what your insurance coverage is and to track your visits. You are responsible for any payment of services that is not covered by your insurance. If your insurance does not cover a service you may have the option to pay privately. ACM will not change billing codes in an effort to receive payment for services that we have knowledge will not be covered otherwise.
Approved Autism Evaluation Centers and Board-certified Behavior Analysts
The following autism evaluation centers have been approved by Blue Cross Blue Shield of Michigan and Blue Care Network.
Common Terms & Questions
What is a co-payment?
This is the amount you pay at the time of service. Co-payments are applied to each discipline you access.
What is a deductible?
This is the amount you are responsible for paying before your insurance begins to cover your healthcare costs.
What is co-insurance?
This is your share of the costs of a health care service. Co-insurance is a percentage of the total charge for the service.
Other Funding Sources
Ask staff about financial assistance and charity care available to support payment of medical expenses or treatment modalities.