Trying to Get Autism Coverage Shouldn’t Feel Like a Full-Time Job—Yet Here We Are
Carmen Londono • April 2, 2025
If you’ve ever tried to navigate insurance coverage for autism-related care, you already know—it’s a whole battle. Like, why does something so necessary come with so much paperwork, so many denials, and so many hoops to jump through? It’s giving “we don’t actually want you to use this coverage” energy.
As a parent of a child on the spectrum, I’ve been there. And as someone who actually knows the insurance industry, I’m here to say: the system is unnecessarily hard, and it doesn’t have to be. So, let’s talk about what’s happening, why it’s so difficult, and how to make sure you’re getting every dollar of coverage your family is entitled to.
Why Is Autism Coverage So Confusing?
Short answer? Insurance companies aren’t trying to make it easy for you.
Long answer? Autism coverage is a patchwork mess of regulations, loopholes, and fine print.
1. Coverage Varies Wildly by State
Depending on where you live, your insurance might cover a full range of autism-related services or barely anything at all. Some states have mandated coverage for things like Applied Behavior Analysis (ABA) therapy, speech therapy, and occupational therapy. Others? Not so much.
So, if you’re in one of the good states—great. If not? You might be paying out of pocket for services your child needs.
2. Not All Plans Are Created Equal
Just because a state requires autism coverage doesn’t mean your specific plan follows suit. If you have a self-funded employer plan, it’s federally regulated and doesn’t have to follow state mandates. Translation? Your employer decides what’s covered, and that might not include autism services.
3. The Approval Process Is a Whole Game
Even when your plan does cover therapy, good luck getting it approved without a fight. Insurance companies LOVE to play the “medical necessity” card—asking for extra documentation, delaying approvals, and denying claims in hopes that you’ll just give up. (Spoiler: Don’t.)
4. Out-of-Network Costs Can Be Ridiculous
Finding in-network providers for specialized autism services? A struggle. Many providers don’t even take insurance because of how much red tape there is. That means families either:
✅ Pay crazy out-of-pocket costs
✅ Fight for out-of-network reimbursement (a whole battle)
✅ Wait months (or years) for a provider to have an opening
All of this while your kid just needs consistent therapy to thrive.
So, What Can You Do to Make Insurance Work for You?
Now that we’ve acknowledged the mess, let’s talk solutions. Because you are not about to let an insurance company tell you what your child can and can’t have.
✅ 1. Know Your State’s Laws
Step one: Figure out what your state requires. You can check resources like Autism Speaks’ state insurance guides to see what you’re legally entitled to. If your state mandates coverage, your insurance company better act right.
✅ 2. Ask Your Employer About Plan Details
If you have an employer plan, ask HR if it’s self-funded or fully insured. If it’s fully insured, state mandates apply. If it’s self-funded? They set their own rules—but you can absolutely advocate for better coverage.
✅ 3. Appeal, Appeal, Appeal
If an insurance company denies a claim, don’t take “no” as the final answer. Many denials are reversed on appeal. Gather medical documentation, have your provider write a strong letter, and push back. Insurance companies bank on people giving up—so don’t.
✅ 4. Keep Every Single Piece of Paperwork
Insurance companies love to “lose” things. Document everything. Keep emails, letters, and records of every phone call with names, dates, and times. When they try to say, “Oh, we never received that,” you’ll have receipts.
✅ 5. Look Into Alternative Coverage Options
If your current insurance isn’t cutting it, check out:
🔹 Medicaid waivers (some states cover autism services even if you don’t qualify for traditional Medicaid)
🔹 TEFRA/Katie Beckett programs (helps kids with disabilities get coverage based on medical needs, not income)
🔹 Private grants & nonprofit resources (there are organizations that help cover costs)
Final Thoughts: Don’t Let Insurance Intimidate You
If dealing with autism coverage feels like a second job, you’re not alone. The system is complicated on purpose—but once you know the rules, you can play the game better than they do.
And if you need someone to break this down for you, I got you. Hit me up, send me your questions, or just vent—because this insurance struggle is real, and we’re in it together.
-Carmen
Ever stare at your benefits enrollment screen (or that 52-page HR doc) and think, “Did I just stumble into an episode of Alphabet Soup: Insurance Edition?” HSA? FSA? HDHP? IRS? It feels like trying to solve a Rubik’s Cube while wearing oven mitts. But don’t stress—I’ve got your back. Let’s unpack two of the most confusing and most valuable players in your health-and-money playbook: the Health Savings Account (HSA) and the Flexible Spending Account (FSA). Here’s the deal: both are awesome. But only one may be the MVP for you. So, What Are They? Both HSAs and FSAs let you stash away pre-tax dollars to pay for qualified medical expenses. Think of them as your personal medical piggy banks—for co-pays, prescriptions, dental work, and even that chiropractor you’ve been low-key avoiding. But they’re not twins. There are a few key differences—like who qualifies, how they’re managed, and what happens if you don’t use the funds. HSA vs. FSA: Let’s Break It Down
Hey Bosses: The “One Big Beautiful Bill” Is Here to Shake Up Your Health Plan. Let’s Not Get Played.
Hey, business owners — While you’ve been out here literally minding your business, Congress slipped a plot twist into your benefits strategy: the One Big Beautiful Bill. Spoiler alert — it’s here to flip how you support your people and how you spend your dollars. If you’ve got a team — or you want to offer real-deal benefits without setting fire to your profits — keep reading. We’re about to unpack what just happened and how to play it smarter than Uncle Sam thinks you will. CHOICE Arrangements & ICHRAs: Your Exit From the Group Plan Hamster Wheel For years, small business owners have been stuck: rising premiums, rinse, repeat, rage scream. This new bill says: “You don’t have to keep doing that.” Say hello to Individual Coverage HRAs (ICHRA) and “CHOICE arrangements.” Fancy names, simple shifts: 👉 Instead of overpaying for a group plan, reimburse your employees (tax-free!) when they buy their own coverage through the Marketplace. 👉 They may get a subsidy. You may get a tax break. And sanity may just return to the benefits process. If you’ve got fewer than 50 employees, this could be your benefits glow-up. Just know — you can’t CashApp them their premium and call it a day. The IRS will not be amused. Follow the rules or risk the consequences. HSAs Got a Mini Makeover You already know I’m Team HSA — tax-free money for healthcare? Sign me up. And now? The updates are actually helpful: ✔️ Spouses can both make “catch-up” contributions to the same HSA. ✔️ Rolling leftover FSA or HRA funds into your HSA is easier. ✔️ Paying for direct primary care? That now counts as an eligible HSA expense. ✔️ More Bronze plans now qualify for HSA use. Translation: HSAs are now easier to use and more valuable. If you offer one, shout it from the rooftops. If you don’t — maybe this is your sign. PBMs Just Got Put on Watch The bill also takes a swipe at shady Pharmacy Benefit Manager (PBM) practices under Medicaid. It doesn’t touch commercial plans (yet), but if you’re self-funded or deal with a PBM? Eyes open. States love to follow the money — and each other. So, What’s a Smart Boss Supposed to Do? Great question: ✅ Still offering a group plan? Run the numbers. If it’s not working anymore, it’s time to consider a hybrid plan, level-funded option, or ICHRA. ✅ No plan yet? CHOICE might be your moment. Do something solid for your team without incinerating your margins. ✅ Already have HSAs? Educate your crew. Don’t let them miss out on tax-free savings. Tell them what’s new. ✅ Call your broker (hi, that’s me). This is not the year to DIY benefits. I’ll read the fine print, review your costs, and make sure you're squeezing every dollar the legal way. TL;DR? Congress keeps remixing the benefits rulebook — but smart business owners don’t get caught sleeping. You don’t have to be the expert here. That’s my lane. Yours is to keep your team thriving, your profits intact, and your accountant off blood pressure meds. Still wondering: ❓“Is my group plan even worth it?” ❓“Should I switch to an ICHRA?” ❓“Could an HSA actually help my team save money?” Hit reply. Let’s run the math before your next renewal hits like a plot twist you didn’t see coming. — Carmen Londono The Insurance Pros
In case it got buried under everything else happening in the world — the “One Big Beautiful Bill” just passed into law, and it’s about to reshape how millions of Americans get and keep their health coverage. Don’t worry — I’ve waded through the 1,000+ pages so you don’t have to. Here’s what actually matters for you, especially if you rely on Medicaid, Marketplace coverage, or tax credits to make health insurance make sense. What’s Changing? Medicaid Just Got Stricter States now have to check eligibility more often — meaning more income verifications, address confirmations, and general paper-chasing. If you’re on Medicaid, don’t be surprised if the mail starts piling up with requests for proof. Here’s the kicker: Miss a deadline, and you could lose your coverage — even if you technically still qualify. Marketplace Subsidies = New Rules, Too Buying your plan on Healthcare.gov or your state’s exchange? Get ready for more eyes on your income estimates. The IRS now has stronger claws to take back your advance premium tax credits if you end up making too much. That old “oops, I earned a little more” cushion? Gone. So if your income shifts? Report it ASAP. It could save you a major headache (and bill) come tax time. Some Bright Spots for Employers and HSAs If you’ve got an HSA with your job — or you are the job and run a small business — this law has a few silver linings: ✔️ More flexibility with HSAs ✔️ New credits for certain employer arrangements ✔️ Easier integration with individual plans Translation: if you play your cards right, you can save tax-free money for medical expenses — and help your people do the same. For Immigrants & Certain Families — Read Closely This law also comes with tighter rules around undocumented immigrants and federal funding for certain procedures for minors, including gender-affirming care under Medicaid/CHIP. If this impacts your household , be especially mindful of eligibility letters or shifts in your benefits. So What Should You Do Now? Check your mail. Seriously. Open it. Respond. There are deadlines. Report income changes quickly. Got a raise? New job? More hours? Log in and update your info. Keep everything organized. This is your season to be that person: save letters, track what you send, and screenshot receipts. Reach out for help. You don’t have to figure this out alone. I do this every day and would be honored to help you sort through what it means for your family. The Big Picture? More paperwork. More hoops. But also — more ways to protect yourself if you stay on top of it. Congress may move the goalposts, but you’ve still got power. Let’s keep your coverage locked in, your paperwork tight, and your tax surprises at zero. Need help? 📬 Hit book a chat. No question is too small — and no one should have to navigate this mess alone. Stay covered. Stay sharp. We’ve got this. — Carmen Londono The Insurance Pros 💙 P.S. Know someone who could use this info? Forward it. We keep each other safe by staying informed.
Your vision plan? It’s out here doing more for your wallet than you probably realize — if you actually use it. Here’s the tea: the average person pays about $8 a month for individual vision coverage. That’s literally two fancy iced coffees, a sad half sandwich, or one of those mystery subscriptions you forgot to cancel. But that $8? It does the most: Eye exam? $10 copay (usually). Without it, you’re paying $50–$100 easy. Frames or lenses? Most plans toss you $150 a year to spend. That’s real money back in your pocket (and better glasses on your face). So yes — your vision plan is basically printing money if you actually use it. And don’t get me started on what else an eye exam can catch: high blood pressure, diabetes, all kinds of sneak attacks on your health. It’s not just about seeing the TV better — it’s about seeing life clearer. So be for real: when’s the last time you got new glasses you actually liked? Or went to your eye doc without side-eyeing the bill? ✨ If you’re an employer: Vision is one of the cheapest, easiest ways to show your people you care — and they love it. Tiny perk, big loyalty. Moral of the story: If you’ve got the benefit — use it. Healthy Vision Month is your sign. Stop squinting at the world when your insurance is begging you to fix it. Got questions about adding vision coverage for your crew? Or whether you’re still getting the best bang for your buck? Slide into my inbox.
Big news, friends — Illinois just made it Facebook Official. We’re breaking up with Healthcare.gov, and starting in 2026, we’re running our own health insurance marketplace. If you rely on the ACA Marketplace, hate glitchy websites, or just want to know what’s happening with your coverage (before it happens to you), grab a seat. I’ve got you. The Breakup Is Real (And Kind of a Glow-Up) Welp, it’s happening. After years of paying the feds to host our Marketplace while they ran the show, Illinois finally said: “We got this.” Starting with the 2026 plan year , you’ll shop for coverage at GetCovered.Illinois.gov . Bookmark it now, thank yourself later. This shift means: Local control 💪🏽 Tailored plan options 🧩 Real accountability 👀 Because honestly? Who knows what Illinoisans need better than... Illinois? Meet the New BFF: Get Covered Illinois Here’s what you can expect when the new platform rolls out November 1, 2025: 🛍️ Browse First, Commit Later Shop and compare plans before creating an account. Knowledge is free — and so are the quotes. 💸 Financial Help Isn’t Going Anywhere Subsidies (like tax credits and cost-sharing reductions) are still available. They’ll just be calculated locally instead of federally. 🧑🏽💻 Real Help, Not Robocalls Whether it’s a Zoom call, text, or in-person meeting, I’ll be here to translate deductible-speak into plain English — no decoder ring required. 🧭 One Site. One Login. No Bouncing Around. ACA plans and Medicaid will now be under one roof. It’s about time. But Let’s Be Real: Transitions Come with Glitches New platform = new hiccups. Expect some: Frozen pages Broken links Confused screens Open Enrollment chaos (we’ve seen it before) That’s why having a broker matters more than ever . I know what “affordable” actually means. I know how to avoid those “looks-good-but-isn’t” plans. I’ll help you keep your coverage clean and your stress low. A Bit of Policy Grit for the Nerds (Love You) This isn’t just a tech rebrand. House Bill 579 , signed by Governor Pritzker, makes this official and gives the state more power to: Prevent shady premium hikes Regulate plans that actually fit our needs Translation? We’re done watching our premiums play Jenga while nodding politely. What You Should Do Right Now 🗓️ Save the Date : November 1, 2025 = new open enrollment 🔗 New URL : GetCovered.Illinois.gov 📲 D o n’t DIY This : Call me, Zoom me, text me. I’ll walk you through it. FAQs (Because You’re Smart Like That) Q: When is the switch happening? A: For 2026 plans. Open enrollment starts November 1, 2025. Q: Will I still get tax credits or subsidies? A: Yes — they’ll just be handled through the new Illinois platform. Q: Do I need a broker? A: Technically no. Realistically? Yes. A licensed broker (hi, that’s me 👋🏽) helps you avoid expensive mistakes and bad coverage choices. TL;DR? Illinois is building its own table. It might get bumpy — but it’s going to be better. And you don’t have to go it alone. 📣 You deserve insurance that makes sense, not one that makes you cry into your coffee. Let’s get you covered — clearly, confidently, and without the chaos. — Carmen Still out here Covering Your ASSets with heart, hustle, and plain-language policy talk P.S. Se habla español. 💬
Protect Yourself Before a Scammer Turns Your Life Into Their Side Hustle.
This month, while the Humboldt Park flags wave high and the streets fill with the rhythm of bomba and salsa, I’m taking a moment to honor someone whose name may not come up during Puerto Rican Pride Weekend—but should. Dr. José Celso Barbosa wasn’t just a trailblazer in medicine—he helped plant the seeds for something we now take for granted: employer-based health insurance . Yes. A Black Puerto Rican physician from Bayamón is credited with developing one of the earliest systems where employers pooled funds to provide healthcare for their workers. Let that sink in. 👨⚕️ Meet Dr. José Celso Barbosa First Puerto Rican to earn a medical degree in the U.S. (University of Michigan, Class of 1880) Faced racial discrimination both abroad and at home Established cooperative health models in Puerto Rico—essentially early employer-sponsored care Believed access to healthcare wasn’t charity. It was justice. He imagined a world where working people didn’t have to choose between a paycheck and a doctor visit. And he built toward it. 🏙 Why His Legacy Still Hits in 2025 Today, more than 150 million Americans receive health coverage through their employer. Whether you love or side-eye the system, the truth is: for many, that coverage is a lifeline. For me, running an insurance agency rooted in advocacy, Barbosa’s work feels personal . Every time I help a business owner protect their team—or guide someone through job loss and COBRA—I’m reminded that this work goes beyond spreadsheets. It’s about dignity. He didn't just advocate. He organized. And in 2025, we need more of that. 💡 3 Small Ways to Carry His Legacy This Month Look at your benefits through a justice lens. Are your part-timers and hourly staff just as protected as your full-timers? Talk to your team. Don’t just send a PDF. Educate them. A confused employee is a vulnerable one. Celebrate Puerto Rican Pride Weekend with intention. Support local Boricua-owned businesses. Learn the stories behind the flags. 🎯 Why This Matters to Me—and Maybe to You Employer-based insurance didn’t start in a corporate boardroom. It started with a Puerto Rican doctor who believed care should be a right, not a privilege. So this June, while we dance in the streets of Chicago, I’ll be thinking about the quiet power of legacy—the kind that shows up in EOBs, provider networks, and someone finally getting the prescription they need. To Dr. Barbosa : Gracias por todo. And to you—whether you’re a business owner, an HR lead, or just someone trying to make sense of this benefits maze—I'm here when you're ready. Carmen ✨ PS: Chicago’s Puerto Rican Pride festivities run June 12–15 in Humboldt Park. Go. Eat well. Dance hard. And bring sunscreen.
Why Your Insurance Bill Looks Disrespectful and How to Fight Back
As women, we’re out here building legacies—owning 40% of U.S. businesses, leading households, breaking barriers, and doing it all with grit and grace. But behind the scenes? 🚨 We’re underfunded. ⚡ We face higher financial risks. 💸 We carry less life insurance. 😬 And almost half of us small biz owners will face a lawsuit at some point. Let that sink in. We’re building empires—without a safety net. What We’re Seeing in the Field As an insurance expert, I’ve seen too many women thriving publicly, while quietly skipping out on the financial protection they need: Not enough liability coverage. No buy-sell agreement in place. Zero disability insurance. Life insurance that wouldn’t even cover the funeral. It’s not because we don’t care—it’s because no one sat us down and made it make sense. That’s why I started The Insurance Pros. Because insurance shouldn’t be a guessing game. Especially for women who are doing the most. How to Play Yourself in 3 Easy Steps (Don’t Do These) Skip coverage to “save” money. Spoiler alert: one ER visit or lawsuit could cost 50x more than a monthly premium. Assume your current policy has your back. If you haven’t reviewed your coverage lately, chances are it’s outdated—or incomplete. Think life insurance is “extra.” If your family or business depends on you, then you are essential—protect accordingly. So What Do We Do? We Move Like the Legends Before Us This Women’s History Month, let’s honor the women who paved the way—by taking ownership of our future. ✔️ Protect what you’ve built. From your LLC to your babies, they all deserve security. ✔️ Know your worth. You’ve worked too hard to leave your assets exposed. ✔️ Lead boldly. Insurance isn’t about fear—it’s about freedom to take bigger, smarter risks. Final Word: Don’t Just Build. Fortify. Whether you’re a solopreneur, CEO, or caregiver with a side hustle—this is your moment. Don’t leave what you’ve built unprotected. Because empowered women don’t just lead. They shield their empire, too. 👋 Ready to Talk Coverage That Actually Works for You? Let’s make sure your business, your family, and your vision are covered. 💬 Book a free strategy session with Carmen today at www.insurepros.net .
Let’s go ahead and say the thing out loud: Men don’t always talk about their health. Whether it’s ego, upbringing, fear, or just not knowing where to start—far too many men delay care, skip checkups, and brush off symptoms like they’re just “tired.” And you know what? That silence? It’s costing lives. June is Men’s Health Awareness Month , which means now is the perfect time to shine a light on the issues that don’t always make it to the group chat—but should. Because “I’m fine” is not a health strategy. And prevention is still better (and cheaper) than crisis mode. Why Men’s Health Deserves the Spotlight Let’s look at the facts: Men die 5 years earlier than women, on average They’re more likely to die from heart disease, cancer, and suicide And yet… they’re less likely to go to the doctor If that math ain’t mathing for you either, welcome to the club. But here’s the good news: A few intentional steps—not major overhauls—can change the game for the men in our lives. 3 Health Moves Every Man Should Make This Month 1. Book the Damn Checkup Seriously. No badge of honor comes from ignoring your blood pressure or that nagging pain in your back. Even a basic physical can detect early warning signs for everything from diabetes to prostate issues. And if you're over 40, get that cholesterol checked . You can’t fix what you won’t face. 2. Don’t Sleep on Mental Health Men are conditioned to “man up” and bottle things up—but depression, anxiety, burnout, and trauma don’t care about your masculinity. Therapy is strength. Vulnerability is power. If you’ve been feeling off, talk to someone. There’s no shame in healing. 3. Know What Your Insurance Covers Many preventive screenings are 100% covered under health insurance. That means free annual checkups, screenings, and more—no excuses needed. If you're unsure what your plan covers, let me help. Seriously. One quick review could save your life and your wallet. 💡 Carmen’s Take Men’s Health Month isn’t about scare tactics. It’s about making health a habit , not an emergency. Whether you’re a man reading this or someone who loves one, use this month as a gentle nudge: check in, check up, and take action . Because we need our brothers, fathers, partners, friends, and sons to be here—not just pushing through pain like it’s noble. What You Can Do Right Now ✔️ Haven’t had a checkup in over a year? Schedule it. ✔️ Not sure what your coverage includes? Reply “Review mine” and I’ll walk you through it. ✔️ Know a man who needs this message? Forward it with love (and maybe a side-eye). You matter. Your health matters. Let’s normalize prevention, pride in wellness, and asking for help when you need it. Not just this month—but always. With heart, Carmen The Insurance Pros
