which summarizes information regarding the new law, including the date on which coverage will begin (some qualifying policies will begin coverage after July 1, 2010), which policies get the benefit of this mandate and which treatments are covered.
Anthem Standard PPO Policy – Significant Error regarding Autism Services
8/12/10
Anthem Blue Cross and Blue Shield made a significant error in its Standard PPO Policy regarding coverage for autism services.
In the bottom left corner of the policy itself (the long document about the policy, often referred to as the “Certificate of Coverage”) is the number BA81 and the document file name 95981_PPO Standard (Rev. 7-10). (You may not have a copy of your Certificate of Coverage, but can request one from your human resources manager or by calling the customer service number on the back of your card.)
At the top of page 38, Anthem states that “Treatment for Autism Spectrum Disorders … must be provided by an Autism Services Provider.” This is INCORRECT because only some of the treatment services that are covered must be provided by an Autism Services Provider (a provider who satisfies certain requirements). A new law (HIMAT) requires certain private health insurance policies to provide coverage for 7 categories of treatment for ASD. Only 2 of those 7 categories are tied to an Autism Services Providers or other specific providers.
It is our understanding the Anthem agrees that this is an error and is presently working with the Division of Insurance to correct the policy language.
See the Overview Document (linked above) for more information regarding HIMAT, including the date on which coverage will begin (qualifying policies will begin coverage on different dates), which policies get the benefit of this mandate and which treatments are covered.
Best Regards,
Jill Tappert
Co-Chair, Public Policy Committee
Autism Society of Colorado
Yes, we did record the conference on June 18th, 2010! Our videographer is working on editing over 6 hours of footage so that we can share it with you on DVD. The DVD's will go on sale soon, probably end of August. We will send an action alert when the DVD is available. To be notified immediately, please
contact Bridget Cessar and she will contact you directly when they go on sale.
HIMAT
