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Wednesday, November 6, 2013

Coverage in Iowa

In Des Moines, WHO-TV reports on implementation of an Iowa law giving state employees insurance coverage for ABA.
Wellmark is the insurance administrator for the state.  In a letter to Wellmark last August, the Iowa Insurance Division directed Wellmark to “establish and implement procedures to pay for statutorily covered autism services.”  It also directed Wellmark to “implement and establish new procedures as quickly as possible due to pending claims.”
Wellmark representatives say the statute is “complicated” and they have questions about exactly who can provide ABA therapy.  In Wellmark’s response to the Insurance Division, it asks for further “clarification and guidance” on matters such as “educational and licensure/certification requirements of such “others” for whom certified behavioral analysts may act as supervisors.
“The insurance company doesn’t want to pay for those services or doesn’t know how to pay for those services when the Board Certified Behavioral Analyst isn’t sitting across the table from the child,” says [Steve] Muller [executive director of the Homestead].  ”And we don’t understand that when other insurance companies pay for that service.”
Wellmark doesn`t lose money by paying the claims because the state is self-insured, the insurance company is just the administrator for the state.