How much do you pay for therapy for autistic or down syndrome kid?

Question

Any parents of kids with those conditions please chime in.

Do you pay for therapy per hour per month etc. ?

Do you go to a hospital or are there centers nearby where you live?

Does insurance cover any of the costs of therapy?

I am working on a business that will give parents a better choice for therapy.

thnx

theo

Answer 1

All disabled kids are entitled by federal law to therapy. The cost depends on the state - some provide it free, some charge the family a portion of the cost. Once they hit age 3 or so, the schools are supposed to provide it for free. Many parents go to private therapists to get therapy not provided by schools or the state, or if they think they're not getting enough. Sometimes insurance covers this, sometimes not. The costs vary widely, but it's never cheap. It's usually paid for per hour-long session, and therapists either come to the home for a small child or the parent brings them to a private practice (rarely to a hospital).

Answer 2

Just a note - most parents would probably prefer that you refer to them as "children with Down syndrome or autism." When you label the child with the disorder, instead of first recognizing the person, many people get offended. I don't mean to be the political correctness police, but that is the way that most people who work with children with special needs are taught to refer to people.

Also, what kind of therapy would you provide for people with Down Syndrome? I can see physical or occupational therapy, but it is not a behavioral or mental disorder. You might want to concentrate on treating children with autism.

You may also want to get in touch with your local school system. Sometimes therapy is provided in or by the schools. At the very least, they may be able to refer clients to you if you establish a positive working relationship.

Answer 3

well I have a child with down syndrome, please don't put a label on my son ie: down syndrome kid...thank you!
as for therapies he has received speech, occupational, and physical since he came home from the hospital through our counties birth to 3 program. our insurance picked up most of it and whatever was left over the county paid the rest. when my insurance was changed we could no longer afford to keep my son on it without paying exuberant prices. so he is on medicaid or title 19 and his therapies are 100% covered. if I had to pay it would be $75.00 an hour. One nice thing about birth to 3 program the therapists came to our house, until we all decided to put him in a group setting when he was 2 yrs. we were given tons of options and did what worked best for us as to the amount of therapy he would require at different stages in his development

Answer 4

In Texas for pre-school aged kids with autism treatment typically costs $40,000 a year, which automatically means that most families can't afford it.

There is a bill up for a vote in Texas trying to make it possible for behavior analysts to get insurance coverage for work with persons with autism and other developmental disabilities.
SB 419... 80R5150 PB-D

By: Lucio S.B. No. 419



A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for enrollees with autism spectrum disorder.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1355, Insurance Code, is amended by adding Subchapter F to read as follows:
SUBCHAPTER F. HEALTH BENEFIT PLAN COVERAGE FOR ENROLLEE WITH
AUTISM SPECTRUM DISORDER
Sec. 1355.251. DEFINITIONS. In this subchapter:
(1) "Autism spectrum disorder" means a neurobiological disorder that includes autism, Asperger syndrome, or Pervasive Developmental Disorder--Not Otherwise Specified.
(2) "Enrollee" means an individual who is enrolled in a health benefit plan, including a covered dependent.
(3) "Neurobiological disorder" means an illness of the nervous system caused by genetic, metabolic, or other biological factors.
Sec. 1355.252. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating under Chapter 842;
(3) a fraternal benefit society operating under Chapter 885;
(4) a stipulated premium insurance company operating under Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a Lloyd's plan operating under Chapter 941;
(7) a health maintenance organization operating under Chapter 843;
(8) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.
(b) Notwithstanding Section 172.014, Local Government Code, or any other law, this subchapter applies to health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code.
(c) This subchapter applies to basic coverage provided under Chapter 1551, a basic plan provided under Chapter 1575, a primary care coverage plan provided under Chapter 1579, or basic coverage provided under Chapter 1601.
Sec. 1355.253. EXCEPTION. This subchapter does not apply to:
(1) a plan that provides coverage:
(A) only for benefits for a specified disease or for another limited benefit, other than a plan that provides benefits for mental health or similar services;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;
(D) as a supplement to a liability insurance policy;
(E) only for dental or vision care; or
(F) only for indemnity for hospital confinement;
(2) a small employer health benefit plan written under Chapter 1501;
(3) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under an automobile insurance policy; or
(6) a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1355.252.
Sec. 1355.254. EXCLUSION OF COVERAGE AND DENIAL OF BENEFITS PROHIBITED. A health benefit plan may not exclude coverage or deny benefits otherwise available to an enrollee for treatment, equipment, or therapy based on the enrollee's having autism spectrum disorder.
Sec. 1355.255. REQUIRED COVERAGE FOR CERTAIN CHILDREN. (a) At a minimum, a health benefit plan must provide coverage as provided by this section to an enrollee older than two years of age and younger than six years of age who is diagnosed with autism spectrum disorder. If an enrollee who is being treated for autism spectrum disorder becomes six years of age or older and continues to need treatment, this subsection does not preclude coverage of treatment and services described by Subsection (b).
(b) The health benefit plan must provide coverage under this subchapter to the enrollee for all generally recognized services prescribed in relation to autism spectrum disorder by the enrollee's primary care physician in the treatment plan recommended by that physician. An individual providing treatment prescribed under this subsection must be a health care practitioner who is licensed, certified, or registered by an appropriate agency of this state or the United States. For purposes of this subsection, "generally recognized services" may include services such as:
(1) applied behavioral analysis;
(2) behavior training and behavior management;
(3) speech therapy;
(4) occupational therapy;
(5) physical therapy; or
(6) medications or nutritional supplements used to address symptoms of autism spectrum disorder.
(c) Coverage under Subsection (b) may be subject to annual deductibles, copayments, and coinsurance that are consistent with annual deductibles, copayments, and coinsurance required for other coverage under the health benefit plan.
Sec. 1355.256. RULES. The commissioner shall adopt rules as necessary to administer this subchapter.
SECTION 2. Section 1355.001(1), Insurance Code, is amended to read as follows:
(1) "Serious mental illness" means the following psychiatric illnesses as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual (DSM):
(A) bipolar disorders (hypomanic, manic, depressive, and mixed);
(B) depression in childhood and adolescence;
(C) major depressive disorders (single episode or recurrent);
(D) obsessive-compulsive disorders;
(E) paranoid and other psychotic disorders;
(F) [pervasive developmental disorders;
[(G)] schizo-affective disorders (bipolar or depressive); and
(G) [(H)] schizophrenia.
SECTION 3. Section 1507.004, Insurance Code, is amended by adding Subsection (c) to read as follows:
(c) A standard health benefit plan must include coverage as required by Subchapter F, Chapter 1355, for treatment for an enrollee with autism spectrum disorder.
SECTION 4. Section 1507.054, Insurance Code, is amended to read as follows:
Sec. 1507.054. STANDARD HEALTH BENEFIT PLANS AUTHORIZED; COVERAGE REQUIREMENT. (a) A health maintenance organization authorized to issue an evidence of coverage in this state may offer one or more standard health benefit plans.
(b) A standard health benefit plan offered by a health maintenance organization must include coverage as required by Subchapter F, Chapter 1355, for treatment for an enrollee with autism spectrum disorder.
SECTION 5. This Act applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2008. A health benefit plan delivered, issued for delivery, or renewed before January 1, 2008, is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2007.


Insurers were already restricted from denying coverage to people with autism but that didn't open them up for coverage: http://www.senate.state.tx.us/75r/senate/members/dist27/pr01/p050801a.htm

There is some info here from Florida, too:http://webmaster-e.com/autism/legislation.htm