Zack Connolly may look like most 12 year olds, but he struggles daily with autism.
“He's more like a 5 or 6 year old when it comes to reasoning, or things like that,” said Zack’s mother Cory Mohammed.
Zack's mom thought her son would be covered when her family purchased a $1,600 a month Florida Blue plan through an Affordable Care Act exchange.
“I have in my mind when I was sending it to them that we were going to start services, we're gonna get all these therapies, everything's gonna get better,” Mohammed said.
But those plans don't cover ABA.
Twenty-nine states have mandated that the therapy not only be provided by private insurance, but also under their healthcare exchanges. Florida does not.
Florida Blue issued the following statement concerning their plans’ coverage:
Florida Blue health insurance plans provide coverage for several Autism Spectrum Disorder treatments such as physical therapy, occupational therapy and speech therapy. Applied Behavioral Analysis (ABA) therapy is not covered by individual plans because it is considered experimental or investigational in the treatment of Autism Spectrum Disorder, as there is a lack of scientific evidence to draw conclusions as to the safety, efficacy or effects on health outcomes.
Florida Statute 627.6686 regarding health insurance coverage of individuals with Autism Spectrum Disorder does not pertain to plans offered in the individual market or any health insurance plan provided to a small employer.
As consumers shop for insurance during Health Insurance Marketplace open enrollment, we encourage them to contact us to help them research specific services, providers or medication they may need so they are fully aware of what is covered by the plans they are considering.