Pediatric Partners, PA

Autism Screening and Insurance Coverage

It is recommended that all children are screened for autism at 18 months and again at 24 months. Unfortunately, some insurance companies allow the code for this service, which means they believe it is a valid charge that a physician can bill, but they put it in the "patient responsibility" category. This means the parent receives the bill for this important service.

We do not want to put our patients and their families in the middle of a billing dispute, but please understand that the physicians and staff at Pediatric Partners strive to provide the best care to our patients. We follow the recommendations and guidelines set forth by the American Academy of Pediatrics. Screening for autism with a standardized screen is a current recommendation. If we fail to do this screening, we are not providing optimal care to our patients. Insurance companies monitor how physicians practice using the codes that we submit to them. The code for the autism screening is submitted to the insurance company. If your insurance company considers this an acceptable service, they allow a charge for the screening. They can opt to pay this charge or to put the charge in the patient responsibility category. This is not up to your physician, but your insurance company. We are not able to know which plans cover various services, as there are many carve outs under each company. Regardless of coverage, it is a recommended test to perform, and we recommend it at the 18 and 24 month visits.

Many things are being done to improve coverage of developmental screenings.

The Kansas Chapter of the American Academy of Pediatrics has been working with insurance companies to cover the code for developmental screening.
Although the state Medicaid and SCHIP programs cover this screen, often traditional insurance does not cover it. The Pediatric council will be meeting with Blue Cross' new medical director to discuss this and other issues regarding reimbursement.
Kate's Law in the Kansas Legislature addresses this issue and if passed will benefit all children.
The Academy of Pediatrics has sent a strong letter of support for payment to all national private insurance carriers, reminding them of the importance of paying for all developmental screens.

If you have had insurance issues with coverage of developmental testing (most often the MCHAT at the 18 and 24 month well visits, but other testing might have been done at another time if indicated by your child's developmental status), please contact your Human Resources person to enlist their aid in talking with your insurance company. Also, personally call your insurance carrier. The more the insurance companies hear about an issue, the more they will listen to the consumers.

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