Health Insurance pic for blogWorking with Insurance companies while getting autism treatment for your child can be complex.  Yet, understanding some basic fundamentals will help you tremendously. Matt Croke, Billing Manager at BY YOUR SIDE took some time to answer questions about insurance challenges, misconceptions and upcoming changes in the industry.

1.What is the most popular question you receive from parents regarding insurance coverage? What's the answer?

What is the total cost for my child's therapy? I see many families struggle with understand how their deductibles, co-pays, co-insurance, and out-of-pocket expenses work. However, if your child is receiving Two or more hours of therapy a week, chances are you will reach your individual out-of-pocket max. The individual out of pocket max is the number I tell parents to focus on. How you reach that out of pocket max is almost irrelevant, all of your deductibles, co-pays and co-insurance count toward that number.  For example: If your insurance policy has an individual out of pocket max of $3,500, your total cost of care for that child is $3,500 for the year. This would include all medical expenses for the child. If we know the families individual out-of-pocket max, BY YOUR SIDE can help by creating a customized payment plan so their child can receive the care that need and help the family from feeling overwhelmed.

2. What do you find is the biggest challenge for parents figuring out insurance benefits for their child's autism therapy?

Starting January 1, 2017, Blue Cross Blue Shield is going to require all policies to receive a pre-authorization for services. Many families already have to get a pre-auth, but not most. Now, they all will. The challenge is to help us out and make sure we have an updated script from the doctor so when we write the reports, we can send them in right away with the script to avoid disruption of services.  The second challenge I would say, is knowing that BY YOUR SIDE will help you understand the policy, but the policy is the families. I get many questions on why the bill looks the way it does. We can of course help families understand the charges, but the insurance companies tell us what is owed. We simply pass the information along through our invoices. We do everything we can to help families understand what can be expected so there are no surprises,but at the end of the day, those policies dictate what total costs will be.

3.  What is a big misconception about autism insurance coverage that you would like to clear up today?

Most parents don’t understand the difference between fully-insured and self-insured. Fully-insured is a policy either purchased on the marketplace or through work.  The business is a small one and they pay the insurance company the full premium. Self-insured is when a large employer funds claims themselves. It is cheaper to do it that way then to pay an insurance company the full premium for (let’s say) 10,000 employees. When a company funds themselves, they may choose their own benefits. They choose what is covered and not covered.  The biggest misconception I often hear is when a parent gets mad at the insurance company for not covering autism and I have to tell them that this was their company’s decision and not the insurance company. Calling the insurance company will do nothing; they need to call their HR department.

4.  What are some helpful resources families can read or watch to learn more about insurance coverage for autism? (i.e. websites, podcasts, books)

There are not many resources out there for this topic. I, myself, have struggled with getting current information. The best resource is to reach out to me at BY YOUR SIDE. I can walk parents through any questions.

5. What is your favorite part of working with BY YOUR SIDE families?

Getting to know families and having a better understanding of their journey. I have so much respect on what they have accomplished and continue to accomplish everyday with having someone with autism in their lives. I learn and am inspired the more I understand their story. It’s a privilege to be a part of this community.

About Matt Croke, Billing Manager

MattCnewpic-300x300borderMatt and his team are responsible for all aspects of the insurance process. From understanding benefits/eligibility of respective insurance policies, to submitting and addressing claims. Matt can be contacted for any information related to understanding your policy in conjunction to services at BY YOUR SIDE. Matt also hosts the BYS podcast, and is always interested in hearing ideas for new topics to discuss or people to interview. Matt can be reached at or by calling 630-590-5571.