5 Year Old Still in Diapers....

If the doc writes a prescription for it then you can order them online through a medical supply place and they can file the paperwork for you. They pay for adult diapers often so I don't know why they wouldn't for a child if the need was great enough.

I'm not sure about your question on diapers, but I have a friend, who has a 19 year old autistic non verbal son, in diapers. I know sometimes when i am with her, she scans the ads to see if the adult ones are on sale, because they are so expensive, so I'm thinking they may not be covered, at least in her case. I'd call the insurance co. and ask.

I don't know the answer to your insurance question, but we're still in the relatively early stages of potty training our globally-delayed SPD 4-year-old. A nurse at Children's Hosp recommended her go-to potty training book "Toilet Training for Individuals w/ Autism or Other Developmental Issues" by Maria Wheeler. I've read about 2/3 so far and have gained some great ideas including picture charts/schedules etc. There are many vignettes of children (some teens) that were finally successfully trained by using this or that approach. (I know this wasn't your question, but I thought I'd toss it out there anyway).

Good luck - I hope you get a positive response from Aetna. We also have Aetna and with a couple of letters of support from our pediatrician, we've (so far) had a positive response for OT, PT, and speech therapies.

Edit to add: I asked my husband about your question, and he did some additional research regarding coverage. He'll take over typing from here:

I can't speak to Aetna's policies, and because I was just laid off, won't be able to ask them until our COBRA coverage kicks in in six weeks. But here are three links which address your question form the point of view of different disorders/diseases, including neurologic ones such as autism. The take home form all seems to be that(1) if your child is enrolled through Medicaid, it is almost certain that diapers would be covered with a prescription from the pediatrician. (2) private insurance covers diapers less frequently, even with a prescription. However, the bellaonline article, written by a mother of a 9 year old with diagnosed autism seems to have had great success with her plan. I am actually uncertain if the plans she describes are Medicaid or private insurance, because she is writing from California and I am in Washington. But they are being covered, either up front or by reimbursement.

If your claim is denied, the second article suggests finding a pharmacy that will bill under general medical supply codes, which seem to facilitate coverage.
http://www.bellaonline.com/articles/art55755.asp
http://www.articles.complexchild.com/jan2012/00356.html

All our best to you on your search for answers. We are interested in knowing your outcomes.

D. and Dave P

M.:

Call your insurance provider. They are the ONLY ones who can answer this question. Each policy is different.

I would also talk to my therapist who is helping my autistic child to find out what I can do to make this happen.

I would also put him in Pull Ups instead of diapers. That's ME. I don't know your life or what you go through on a daily basis - but if my child was 5 - I would not have them in diapers. I would chose pull ups for him.

GOOD LUCK>

ETA: Diapers are NOT covered via Flex Spending accounts unless a prescription is written for them - that's all the new changes that took place in 2009/2010...if you have a FSA - call them and verify they do not cover that.

If you have an HSA card - you MIGHT be able to purchase them that way. I don't know.

Your best answer will come from Aetna themselves. Call the 800 number on the back of your card. Good luck,

UPDATE: in case it's not covered, look into flex spendings accounts - the kind that you can use pre-tax dollars for medical expenses and see if diapers would be covered.

Not sure how it works there, but my son was diagnosed with PDD-NOS and we receive some funding through the County Board of Developmental Disabilities, which covers the purchase diapers, pediasure, etc. with a doctor's prescription.

Is your insurance paying for ABA? If so, your ABA therapists will help you with potty training. Potty training for autistic kids is harder for many reasons, including sensory issues--some kids may not feel when they are wet, for some it takes a puddle on the floor to realize they've had an accident. It's best to coordinate your home program with your providers--therapists, preschool/school--for the training to be successful. What is your mental health benefit? Some families have gotten referrals to child psychologists who helped with potty training and other issues. I know WA state is in the minority of US states that don't mandate autism coverage but the public employee insurance providers in WA are now required to pay for ABA thanks to a lawsuit. As far as diapers are concerned, talk to your insurance, talk to your pediatrician and developmental pediatrician, talk to the county/state service providers who work with your son. The insurance people may be least helpful. Have you checked with any autism specific organizations in WA? Is there an Autism Society for Washington?

Not sure about the insurance part. I would say on the toilet training, I would put him in underwears underneath pullups and that way he feels it a little more, without a big mess. You can just keep work on reminding him to go, and you can use some of the advice on here to see if there is more you can do to toilet train him. I understand he has special needs. I'm sure he will like being able to go on the toilet all the time. Just because he is non verbal does not mean he doesn't understand. I think possibly more effort into toilet training him would be a good idea.

Yes, insurance will pay. We have Aetna too. but we are having diapers trough medical when my son was 3 yo, you should be qualify too since your child is Autistic.
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I would call the insurance company and check. My son is special needs but not diagnosed autistic. He is non-verbal. I put him in pull-ups at 5. He was finally potty trained at 8 for awake hours only. We are having problems with night time. He does not know how to request to go, we have to ask him every so often. For school, I had to tell them to take him to the bathroom when he arrives at school because of getting up at 5 then being on the bus till 7:00. They didn't listen and he had an accident so now they listen. IF he drinks more than usual in the morning, I write them a note so they can take him more often throughout the day instead of by the schedule. Keep working on it, you will get there.
There is an agency here that gives vouchers every month up to a certain amt per year for adult diapers. We have to submit our yearly earnings amt each year and thats how they determine how much we get. Right now, we are allowed $500 for any medical expense for a whole year.