Requesting Insurance Coverage from Your Employer
Once you have determined that your insurance is self-funded by the employer, ask you HR whom you should talk to about increasing coverage for therapies for children with disabilities. Also, find out what your plan currently covers. You will need to know this entering the meeting to request a change.
Set up a meeting with the person or people who make insurance decisions. Let them know that you want to discuss a chance in state law related to therapies for children with disabilities. Have the below handout ready to share with your employer. You might also want to take your child's progress sheets from therapy or other information that show the impact of therapy.
Here is some information you might choose to share:
Missouri passed an autism mandate in 2010. This mandate requires insurance to cover therapies for children with autism. This law has been very effective. The cost has been minimal to insurance and the results have been overwhelmingly successful. While only fully-insurance plans have to honor this mandate, many self-funded businesses chose to follow this mandate. (Check ahead of time to see if your employer honors the autism mandate.)
In July, this autism mandate was amended to include children with any disability. This change had overwhelming support by legislators and was even endorsed by the insurance lobby.
Talk about your child and why insurance is important for your child. Share the cost and how that impacts your family.
Don't skirt around the issue. Ask your employer to honor the new law and expand insurance coverage for therapies to include children with disabilities. Talk about some of the points on the handout.
Money matters. Make sure to point out the low costs. Also, if your employer already covers speech and some OT or PT, mention this. The claim cost increase will be even lower than $.39 per member per month.
Have an open dialogue with your employer. Give him or her plenty of time to ask questions. This is a great time for your employer to learn more about you and your child.
When the meeting is done, thank your employer for the chance to talk. Later, send a follow up email to the employer. Thank him or her for taking the time to meet with you. Be direct and reiterate that these therapies are important and you hope that they will be covered by insurance in the future.
We hope this helps. If you have any other tips or suggestions, we'd love to hear them. We don't want to script your meeting, as we think natural conversation is best. Just remember--you are the expert on this topic. You know your child and why therapy is important better than anyone else. Please send us an email letting us know how it goes. Good luck!