Mother of special needs child forced to change insurance coverage that doesn’t cover child’s condition

Lisa thought she had learned to deal with a fairly complicated life. Her infant son, Ian, got sick after a measles/mumps/rubella shot and had to be hospitalized. They did a lot of tests, but couldn’t find a cause for the episode. But by the time Ian was 18 months old, this folks knew something was wrong. He was losing his ability to communicate. Years later his condition was finally labeled as autism.

Now Ian is 12 years old and needs a lot of care. Lisa teaches him at home, but can’t provide the physical, occupational and speech therapy he needs to remain functional. When her husband’s company was bought out by a national company, they were elated he didn’t lose his job, but it didn’t take long to discover the new company’s health insurance coverage was going to be very different under United Health Group, a for-profit insurer located in Minnesota, but not authorized to insure at Minnesota-based companies.

After three months of continued therapies under the new employer’s plan, Lisa discovered that UHG wouldn’t cover therapy unless it is for a new injury. The denial left them with a $3,600 bill. After receiving large numbers of complaints from other employees, Lisa’s husband’s company switched to Blue Cross.

“You still need to be really careful with autism,” Lisa said. “ Insurance companies don’t understand it. We need to get a doctor’s order for everything. It costs me co-pays for a doctor visit, then co-pays for the therapist…even in their network.”