Question:

My son has a diagnosis of Level 1 autism from Utah – I have heard that he must be retested by a certified autism center in Michigan to receive coverage for things like ABA therapy. Can you tell me if this is true, is there any way around this (I hate putting him through all of this ongoing extensive testing) and if it is true how to get on a waiting list. Thanks!

Answer:

Re-testing at an approved autism evaluation center (AAEC) may or may not be needed.  Some insurance providers like Blue Cross Blue Shield of MI and Blue Care Network require an AAEC evaluation to make or confirm a diagnosis of autism in order for applied behavior analysis (ABA therapy)  to be covered, but other insurance providers do not have this same requirement. If your insurance plan offers an autism benefit, call the mental health service number on the back of your card and ask what is needed to establish eligibility for autism services.

If your child was evaluated for autism within the past year and an AAEC evaluation is required, the AAEC team may choose to review previous test records to determine if any additional assessment  is necessary.  In some cases, a full re-evaluation may not be needed, but if your child’s evaluation is over a year old and was not comprehensive, additional testing will probably be needed.

A comprehensive autism evaluation should include assessments of language and communication, adaptive behavior, social abilities, and behavioral, cognitive and emotional functioning. A thorough medical history and examination should also be completed along with parent or caregiver interviews (Autism Diagnostic Interview-Revised/ADI-R) and observation of direct play Autism Diagnostic Observation Schedule/ADOS).  If an autism diagnosis is made or confirmed, the level of support needed should also be specified:  Level 3- requiring very substantial support, Level 2-requiring substantial support or Level 1-requiring minimal support.

Contact any AAEC  to schedule an appointment.  A list of AAECs in Michigan can be found by clicking on the following link.  List of Approved Autism Evaluation Centers in Michigan

If you need additional help understanding your autism benefits, identifying whether or not your child needs a re-evaluation, or determining where to go for testing, let us know!  Call the Autism Alliance of Michigan (AAoM)  at 877-463-2266 or click on MiNavigator Program to request a free AAoM Navigator who will work with you to answer your questions and get you where you need to be!

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