Autism Parent Resource Center
Below are resources to assist parents of children with autism spectrum disorders - no matter where they are in the process of finding treatment for their child. It is also intended to assist parents in navigating the health care system for the first time with health benefits or insurance.
- Make sure that your autism service provider is licensed by the state of Missouri. Look up your provider on the Missouri Division of Professional Registration's website.
- After your child has been diagnosed and your provider discusses what treatment options they recommend, you should call your insurance company. You need to ask if they require prior authorization or pre-certification for that type of treatment. If so, you need to ask what their procedures are for prior authorization or pre-certification and, most importantly, what information or documentation they will require to preauthorize or pre-certify the treatment – do they need just the treatment plan or any additional information? Also, you should ask if each type of treatment or therapy will need to be individually pre-certified or just the treatment plan.
- You also need to verify what address or fax number your provider’s office will need to send this information to. You may need to provide that information to your provider’s office staff.
- Make sure that you take notes of your call that include the date and time of your call and the name of the person you spoke with.
- If you send any information to the insurance company, make sure that you send it in a way that gives you some proof of delivery – be it a fax delivery confirmation, certified mail or overnight delivery.
- Keep a copy of any information or documents you send to the insurance company.
- Follow up with the provider’s office to make sure that they have provided everything your insurance company requires and that they have received the preauthorization or pre-certification number – prior to your child’s first treatment appointment. If the insurance company required a separate pre-certification for each type of treatment or therapy, make sure that each provider has obtained that pre-certification number. You need to keep a record of any pre-certification numbers that you or any of your providers obtain.
- Make sure that you understand the difference between in-network and out-of-network coverage. If you use a medical provider that is in your health plan’s network, that may mean you will pay less out of pocket. Some health plans, like Health Maintenance Organizations (HMOs), may not pay for treatment if you do not use a network provider (and there are other providers available in their network).
- If a treatment or claim is denied, be sure to appeal the denial. Missouri law requires that insurance companies have grievance or appeals processes that you can utilize. You can also call DIFP’s Insurance Consumer Hotline for more information on grievance and appeals.
- If you are still unsuccessful, you can file a complaint with DIFP. The department cannot make medical determinations; however, we have a process called external review that can resolve adverse determinations regarding covered services.
Autism FAQ - answers to questions about the new law.
Missouri Department of Mental Health, Office of Autism Services
The Office of Autism Services was created in 2008 with the passage of Senate Bill 768, which also created the Missouri Commission on Autism Spectrum Disorders. The role of the Office of Autism Services is to provide leadership in program development for children and adults with autism spectrum disorders, to include the establishment of program standards and coordination of program capacity. The Office of Autism Services provides substantial technical assistance to the Commission in its charge to develop a comprehensive statewide plan for an integrated system of training, treatment, and services for individuals of all ages with autism spectrum disorders.
The office website has a number of resources and information for parents who have children with an autism spectrum disorder, or who believe their child may be in the autism spectrum.
Making sure your child’s autism treatment is reimbursed by insurance - a step-by-step guide