What Insurers May Require Before Covering ABA in Michigan
The statute gives insurers specific conditions they may attach to autism coverage. Knowing them helps HR explain why paperwork is requested.
The conditions the statute allows
A diagnosis
A licensed physician or licensed psychologist must diagnose autism spectrum disorder before coverage applies. The state autism program says a carrier may require an evaluation every three years.
A treatment plan and review
The insurer may require a review of treatment consistent with current protocols and may require a written, individualized treatment plan. A review the insurer asks for is at the insurer’s cost.
Diagnostic observation schedule
The insurer may ask for the results of the autism diagnostic observation schedule used in diagnosis, and may ask that it be repeated no more than once every three years.
Annual developmental evaluation
The insurer may ask that an annual developmental evaluation be done and the results submitted.
Back to the ABA guide.
What Insurers May Require Before Covering ABA in Michigan: short answers
Can the carrier require a treatment plan?
Yes. The statute says an insurer may require a treatment plan as a condition of coverage, along with a review of treatment.
Who pays for the treatment review?
If the insurer requests the review, the cost of the treatment review must be borne by the insurer.
How often can the carrier ask for the diagnostic schedule?
It may request that the autism diagnostic observation schedule be performed no more frequently than once every three years.
What Insurers May Require Before Covering ABA in Michigan: not legal advice. Send us your renewal.
Where these details come from
The laws and rules named on this page link to the official text. This is general information, not legal advice, and rules change, so check the current text.
MCL 500.3406s, Insurance Code of 1956
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