20100512-IR-760100252NRA April 27, 2010 Bulletin 179

DEPARTMENT OF INSURANCE

April 27, 2010 Bulletin 179

Pervasive Developmental Disorders Coverage Clarification

This bulletin is directed to all insurance companies that issue accident and sickness insurance policies as defined in IC 27-8-14.2-1 and to health maintenance organizations (HMOs) as defined in IC 27-13-1-19. This bulletin amends and clarifies information provided in Bulletin 136, dated March 30, 2006. This bulletin is intended to provide guidance to insurers and to consumers on the administration of claims for treatment of Pervasive Developmental Disorders (PDD) as required by IC 27-8-14.2 and IC 27-13-7-14.7.

Bulletin 136 states, "A written treatment plan for each individual with PDD must be developed and signed by the treating physician.". The Department is aware that general practitioners may not be involved in the development of a treatment plan for an individual with PDD. Therefore, treatment plans signed by psychologists or physicians specializing in the treatment of PDD and treating the covered individual with PDD are acceptable for submission to the insurer or HMO. Psychologists and physicians specializing in the treatment of PDD are considered the treating physician for the purposes of PDD coverage.

Questions concerning this bulletin should be addressed to Robyn S. Crosson, Chief Deputy Commissioner for Company Compliance Services, who can be reached at [phone] or [e-mail].

INDIANA DEPARTMENT OF INSURANCE

______________________________________

Doug Webber, Acting Commissioner

Posted: 05/12/2010 by Legislative Services Agency

DIN: 20100512-IR-760100252NRA

Composed: Nov 01,2016 12:54:50AM EDT

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