Insurance Company Changed Mind About ASD Service Coverage? How do Florida Laws Apply? (FL)
Some facts to keep this short:
My son was diagnosed with Autism in the fall of 2021. Official diagnosis.
We had him enrolled in Speech (SLT) and Occupational Therapy (OT) before the diagnosis was official.
Our insurance year starts on October 1st. We opted for a better (most costly) plan with a lower deductible. I called United Health Care before the insurance year started to ask about how therapies work.
I was told that he would get 60 visits combined for all therapies. When the 60 were up, we could request additional appointments through our provider (showing medical necessity).
After the insurance year reset and his diagnosis was official, I called again. I was told again that we could request additional sessions after the 60 were used.
STL and OT recommended 2 sessions per week per therapy (4 per week). We pay $40 copay for each visit (ouch). His max out of pocket is $3k. Anyhow, we were set to run out of visits in Feb.
I called UHC again to ask about how to request the additional visits (I had new evaluations, goals, etc.), and they told me that the 60 limit was hard. They claimed that there is no way to get more. I explained that I was told differently and made decisions based on that information. This was escalated to a supervisor who pulled the phone recordings of those conversations. She confirmed that I was told we could request additional sessions. She also said there is nothing she could do (that the person who told us that wasn’t authorized to say as much, etc.). Apparently, they are now discussing it with other people (the employer who provides the insurance, I think). It’s been a couple of weeks and they just keep telling me they are working on it. In the meantime, we lost both of our OT providers since we couldn’t schedule.
STL and OT are super expensive. Had I been given the right information, we would have spread the services out over more of the year. I’m paying for other therapies (not covered) and trying to get him into our local special service pre-k (the schools here aren’t great and the process is a nightmare).
Anyhow, I’m wondering if there is any legal action I could take. They won’t give me the phone call recordings without demand from a lawyer. I then learned that there are laws protecting people with Autism from not getting services. Sadly, I’m not sure I understand it. One article is here. The law is here (I think).
It says that “certain” insurance companies provide coverage for therapies. It also has a max of $200,000 for life? I guess I don’t what these services cost, but it doesn’t seem like $200k is much for life-long services.
I think I’m just confused by the entire situation. I’ll keep talking with UHC, but do I need to consult an attorney? Am I missing something?
TL;DR: insurance company told me one thing and then told me another. Phone call recordings show that they did tell me; now they are giving me the run-around. I also found a Florida law that may prohibit them from denying therapies for my autistic son. Am I getting into hiring a lawyer territory?
