When Kentucky passed a law in 2010 to require insurers to cover autism treatment, Heather Dales felt like a weight had lifted off her family.
Until she billed the insurance company.
Since the law took effect in early 2011, Dales said the plan failed to reimburse her and her husband for tens of thousands of dollars' worth of care. Most of it paid tuition to the Highlands Center for Autism in Prestonsburg, Ky., which she said drastically improved the development of her son, Hunter, now 6.
Dales said the insurer has denied most of the claims, citing incorrect billing codes or use of an unqualified therapist - among other reasons. The couple first turned to family fundraisers - and now loans.
"We can't keep taking loans out," she said.
In the past few years, more than half the states have passed legislation mandating some level of autism coverage, according to the National Conference of State Legislatures. But some families of autistic children say they've received little or no benefits.
Insurance companies in Kentucky say the state's mandate has required a smoothing-out period to address legal gray areas and other unforeseen challenges. Autism advocates say insurers have had plenty of time to cover everyone who's eligible.
"I don't see any basis for why this should be happening two years down the road," said Daniel Unumb, executive director of the advocacy group Autism Speaks. "I think they're still looking for a way to avoid the broad policy and the mandate."
Some states with mandates have taken action against insurers.
Last month, California issued emergency regulations to get plans to comply with the law after the state received 71 complaints. Missouri's Department of Insurance took action in September against insurer Aetna for excluding autism coverage, which resulted in the company donating $250,000 to a nonprofit treatment center.
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Despite law, some families lack autism coverage