Neurodiversity Member Guide
What is neurodiversity?
Neurodiversity describes the natural variation in how our brains process information and how we interact with the world around us. These variations include many different ways of thinking, learning, and behaving. People with neurodivergencies may, however, experience different strengths and struggles.
Use this resource to better understand services and coverage on the Surest plan. Surest Clinical Advocacy can help you navigate your care.
Autism Spectrum Disorder
Autism spectrum disorder (ASD) is characterized by difficulties with communication or social interaction. Specific causes aren’t fully understood, and symptoms vary.
Check the Surest app or website to find costs and coverage for common services, including:
Applied Behavioral Analysis (ABA) therapy
ABA is a type of therapy to help improve communication, focus, and social skills by focusing on behavior through encouraging desired behaviors. The therapy may involve a range of programs based on response to the service.
Check your plan to ensure you have coverage for ABA therapy; and if so, any age and/or network requirements.
Your pediatrician or family doctor will start this process with a developmental evaluation. A qualified ASD assessor can then complete an ASD assessment.
Surest advocates can help you find a provider.
Once a plan of care is established, the provider should submit prior authorization for ABA therapy through the provider portal. Even if you choose to see an out-of-network provider, ABA therapy requires prior authorization.
The provider portal for ABA therapy can be found here.
Physical therapy, occupational therapy, speech therapy (PT, OT, ST)
Physical, occupational, and speech therapy can help with mobility, speech, and activities of daily living.
For ASD and other behavioral health services, there are no limitations on the number of covered visits.
For other diagnoses, limits may apply based on the benefit documents.
Search the Surest app or website to find copay information.
Cognitive behavior therapy, dialectical behavior therapy (CBT/DBT)
- Talk therapy to help with emotional regulation, thinking patterns, behaviors
- Individual and/or group therapy
- These services are generally covered under general outpatient psychotherapy benefits
- Biofeedback
- Can help develop new habits and patterns and reduce anxiety
- Check your plan by searching “biofeedback” on the Surest app or website
- Art/music therapy
- Can help with emotions, expression
- Not covered as a separate benefit, but may be included as part of ABA therapy
Adults with ASD and their caregiver(s) may benefit from services as well, such as virtual mental health visits, in-office mental health visits, cognitive behavioral therapy, and dialectical behavior therapy (CBT, DBT). These services are generally covered under outpatient psychotherapy benefits. For cost and coverage, search the Surest app or website.
ADHD
Attention-deficit hyperactivity disorder, or ADHD, is a developmental disorder characterized by difficulty paying attention, impulsivity, or having trouble focusing or concentrating. Symptoms are often noticed at an early age.
Services for ADHD may involve a combination of approaches:
- Education or training found in support groups and local resources
- Comprehensive evaluations by providers including input from family and caregivers
- Cognitive behavior therapy (CBT), dialectical behavior therapy (DBT):
- Talk therapy to help with thinking patterns and impulse control
- These services are generally covered under outpatient psychotherapy visits benefits
- Medication
- A neuropsychological evaluation—search the Surest app to find cost and coverage
Dyspraxia
Dyspraxia, also known as developmental coordination disorder, affects physical coordination and fine motor skills, gross motor skills, and coordination between the two.
Services for dyspraxia can include:
Physical therapy, occupational therapy, and/or speech therapy (PT, OT, ST)
- Therapy may help with mobility, speech, and activities of daily living
- Check your benefits and find a provider on the Surest app/website or call Member Services for cost or coverage confirmation
- For the purpose of treating behavioral health conditions, there are no limitations on the number of covered visits
Talk with an advocate
The Surest Clinical Advocacy team offers an extra layer of support to help you find providers, navigate benefits, understand costs, and more.
“We’re very proud of our Clinical Advocacy team and their ability to help members find care,” says Norris Vivatrat, MD, Surest Chief Medical Officer.
The areas of specialty are wide-ranging, including specialists in pediatrics and neurodiversity.
Surest clinical advocates are ready to:
- Help you understand your cost and coverage
- Give you information to find high-value network providers
- Assist with finding services, providers (including virtual providers, when available), or resources
- Offer support in choosing applicable treatment options
Resources
- Association for Autism and Neurodiversity
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
- Dyspraxia Foundation USA
- Search the Surest Health Library for more information.
Was this helpful?
This content is not medical advice. You should always consult with your health care professional.
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