Hi Eric, a self-funded group is different from a premium rated group. Self-funded groups have a different financial arrangement with us and pay their own claims. We do offer an optional benefit for self-funded groups to cover autism services – and you could inquire of your company whether they have considered adding it.

I was told by BCBS customer service representative that my current plan (self-funded) doesn't include Autism service. Since "Premium rates for members with group or individual coverage will not change as a result of the expanded autism benefits.", could my company add autism service to our plan at anytime?

I have a 4 year old child that we are trying to get assessed for ASD (Aspergers Syndrome). Your requirement that members are required to to go to a BCBS- approved AAEC is a hardship for a lot of use who live in rural areas. The closest AAEC is over 1 hour and 1/2 away and they are booked until at least 2013 (we can only get on a waiting list). There is a doctor that is only 45 minutes away that can do the Assessment (and, in fact, is world renowed for his work in ASD) but is NOT with AAEC. This particular doctor is a BCBS provider (affiliated with Borgess Health) and I have been told by YOUR representative that his dx will be COVERED by BCBS (PPO). My daughter was originally on MIChild (to help save us some money) but I took her off and put her on my private pay coverage (PPO)because I was told the dx would be covered under my private pay but NOT covered under MIChild. However, your website now says her diagnosis must be from an AAEC. There is a mandate now for autism coverage nd it seems all the insurance companies care about is finding any kind of loophole to NOT pay OR making it so convoluted that we give up. This is unfair after we have fought so hard to get this law passed!!! Do you understand that time is of the essence for our children. Research has shown that if these children are given treatment early on, they can function relatively normal (and, in putting it in terms YOU understand, the cost in the long run will be much less for not only the insurance companies, but society as a whole). Many of us cannot afford to wait over a year for assessments to be done at AACEs. Do you not understand that there is a shortage of not only BCBA therapists in MI, but also a shortage of AAEC centers (per AAOM). It doesn't make sense to many of us that you will pay this doctor if he is simply doing your run-of-the-mill pediatric assessments, but will not recognize and pay for further Autism treatment because his diagnosi is NOT done by an AAEC.

Autism treatment is an important issue for families and we continue to expand the number of AAEC's and BCBA's in the state to help ensure access to care. An updated list was posted this morning: http://www.bcbsm.com/pdf/aaec.pdf Mandated coverage for autism treatment is new to all insurers and health care providers in Michigan, and our focus is to build the appropriate networks to meet the needs of the community. You can also use the provider search on bcbsm.com and mibcn.com for updates on AAEC's or BCBA's. Regarding reimbursements and the participation of ABA treatment centers, there's a lot of misinformation out there right now. We’re working to grow the network as quickly as we can and to establish fair and competitive compensation for our providers.

Dear BCBS of Michigan: my son was diagnosed with Autism. He has received physical therapy, speech therapy and occupational therapy. He also received music therapy, sensory therapy and we spent most of our retirement savings to get him the help he needed. I do not expect your organization to help us although that would be a pleasant surprise. It's a shame that you needed a law passed in order to expand benefits for families with autism. It only adds to many people's perception that you only care about money and not people's health. Why is it that you have to be forced to do the right thing? By the way, no one believes you should be designated as a "nonprofit." If you want to impress me you should have someone from your organization contact me directly, and I mean someone who can actually do something about it.