Open enrollment is approaching and there are a number of questions you may have about insurance coverage along with the process to access treatment. Insurance plans are not universal. Some plans follow state laws while others do not, which can make the decision for your family more difficult. We understand the confusion and have provided some helpful information as you navigate through your options.
Employer Provided Insurance:
Whether your insurance is changing or staying the same through your employer, make sure to verify that the insurance carriers and types of plans offered for ABA services are still covered in 2019. Enrollment periods may vary with each employer. We recommend you reach out to your employer’s HR representative to discuss enrollment and benefits regarding your ABA coverage.
Within private insurance plans, ABA coverage can vary, even if you keep the same provider. It is important for you to stay in communication with your HR representative, your insurance company, and Gateway to prevent any issues with your child’s services.
General open enrollment for 2019 begins November 1st, 2018 and lasts until December 15th, 2018. You can renew your current health insurance plan or choose a new plan through Marketplace. This option is in addition to, or in lieu of, any employer provided health insurance.
You cannot sign up after open enrollment has ended unless you have a Qualifying Life Event (ie: marriage/divorce, change in employment, birth of child, etc.). This does not apply to Medicaid plans.
WHAT WE NEED FROM YOU
A patient insurance form will be available to each family. This form will include all necessary information pertaining to your family’s insurance plans. If you receive the patient insurance form in the mail please make sure it is completed, signed, and returned to Gateway no later than Monday, December 17th, 2018, as it is an essential part of the ABA Therapy process. The form will be available upon request at your clinic’s front desk or from your child’s supervisor. It takes time for providers and insurance companies to make all necessary adjustments when plans and policies change, so please submit your completed form as soon as possible.
We understand that navigating your insurance can be difficult. The insurance team at Gateway is happy to work alongside our families in any capacity that we can, but as the policy holder you will have more access to your insurance information than we will. We encourage you to call the customer service number on the back of your insurance card to find out about your benefits, copays, deductibles, and the ABA coverage that is provided within your plan.
With the deadline for choosing next year’s health plan approaching soon, Gateway is working to gather all necessary information to make the transition as smooth as possible. In order to do that, we need your help!
Who to Contact at Gateway:
- Nicolette Lulgjuraj
- Stephanie Smith
- Lauren Stroinski
How Insurance Changes Can Affect Services:
Insurance changes include, but are not limited to: switching insurance carriers, changing groups within an insurance plan, changing policy numbers, or potentially losing ABA coverage. Each insurance company has their own specific requirements for diagnostic paperwork and acceptable locations where the diagnostic evaluations can take place. Please understand that a change in insurance provider could mean a new evaluation will be required. All adjustments to insurance plans must be submitted to Gateway in order to prevent any issues with your child’s services. Failing to notify Gateway can result in a delay or pause in services.
For more information, please review Autism Alliance of MI’s October 2018 newsletter at https://t2m.io/CFGixhyM