Funding & Insurance

The Good News

What's Typically Covered

Understanding Your Coverage

Call your insurance company and ask:

• "What autism services are covered under my plan?"
• "Is there an age limit or hour cap?"
• "Do I need pre-authorization?"
• "Is there a deductible or copay?"
• "Do you have a list of in-network providers?"
• "What's the process for out-of-network reimbursement?"

When They Say No: The Appeal Process

Most denials can be appealed. And most appeals are won by parents who don't give up.

Step 1 — Get the Denial in Writing

Request the specific reason for denial and the policy language they're citing.

Step 2 — Gather Your Evidence

• Diagnosis documentation
• Medical necessity letters from providers
• Treatment plans with measurable goals
• Progress reports showing benefit
• Research supporting the treatment

Step 3 — Write Your Appeal

Include: your child's diagnosis and specific needs, why the service is medically necessary, how it meets the plan's criteria, supporting documentation, and a request for expedited review if urgent.

Step 4 — Follow Up

Insurance companies count on you giving up. Don't.

• Call weekly to check status
• Document every conversation (date, name, what was said)
• Request supervisor review if needed
• File a complaint with your state insurance commissioner

Other Funding Sources

Medicaid / Medicaid Related Waivers

Even if you have private insurance, your child may qualify for Medicaid based on their disability (not your income). Waivers provide additional services. Check: Medicaid.gov · NC-Exceptional Children

Early Intervention (Birth to 3)

Free, federally mandated services under IDEA Part C. Contact your state's early intervention program: CDC Early Intervention Guide

School District (Age 3+)

Schools must provide services in the IEP at no cost to you. This is separate from insurance.

Grants and Nonprofits

• Autism Speaks grants
• ACT Today! grants
• United Healthcare Children's Foundation
• Local autism foundations

Keeping Records

Create a system to track: all claims submitted, Explanations of Benefits (EOBs), denial letters, appeal correspondence, and phone call logs.