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Navigating Through Health Insurance

Navigating Through Health Insurance

Navigating Through Health Insurance

It’s that time of year again- open enrollment for health insurance/healthcare plans. Maybe this topic is familiar to you, maybe this is your first time even having to deal with finding a plan. Not for PediaPlex though, we have dealt with insurance and come out on the other side! We are here to help you navigate through this tricky season and help you know what questions to ask when searching for the best insurance coverage for your family or child. These tips can be helpful when picking out a private policy or when purchasing a new plan through your employer.


Important Dates:

For the majority of insurance and healthcare plans, open enrollment opens on November 1st and will remain open until December 15th. Please, please, please do not try to wait until December 13th to sit down and figure this out- START TODAY! There will be a lot of different plans to look at and a lot of questions so you will need to give yourself more than enough time to prepare.  It will be extremely important for you to compare the plans and check that your preferred providers are in-network with these plans. The policy you are picking out will start on January 1st, 2021.

Important Questions:

Now, you may not have luck calling your insurance company or agent and asking specific questions about coverage. BUT, what you can do is ask for a copy of the health insurance plan to scan through and check it. If you are someone who has insurance through a new employer, make sure to look at these questions as well when choosing your new policy!
              -Is the diagnosis of autism covered? (F84.0)
              -Is Applied Behavior Analysis (ABA Therapy) covered? (CPT Codes: 97151, 97153, 97155, & 97156)
              -Is there a yearly limit on Speech or Occupational Therapy sessions? Is that limit combined or separate?
              -If there is a diagnosis of autism, does the above limit get waived?
              -Does ABA Therapy place a weekly limit on hours once the child reaches school age? (6 for state of Texas)
              -Is there an even further reduction once the child reaches age 10?

Navigating Through Health Insurance

We know- you probably have a lot of other questions and your main goal is to pick the perfect plan for your child. If you are unsure and nervous about this process, PediaPlex recommends speaking with an insurance broker who has experience with autism. They can help you even further and make sure you are getting the correct plan for your family- and hopefully will help you save money in the end!

Even with health insurance, therapy can get very expensive very quick. Make sure you also look into grants that might be available for your child. There are a variety of grants out there that will help cover SpeechOccupational TherapyABA Therapy and other therapies that your child might need. We are here to help!

At PediaPlex, we accept AETNA, Blue Cross Blue Shield, Cigna, Scott & White, and United Healthcare.  As a reminder, every policy is different so we will verify your benefits before we start with services to make sure you have coverage.

 If you have questions, give us a call today at (817)-442-0222.

PediaPlex is not able to guarantee coverage by insurance. We will help you verify your benefits in the new year. All coverage is based off your insurance provider, your employer’s policies, and diagnosis.

-The PediaPlex Family

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