Insurance Resource Center for Autism and Behavioral Health

19/02/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I submitted my MassHealth Premium Assistance application two weeks ago but haven’t heard anything yet. I called MassHealth and they couldn’t give me a status update. Can you tell me if it was received or approved?

— Status-Check Sam"

Dear Status-Check Sam,

The Insurance Resource Center can provide the Premium Assistance application and explain how to complete it — but once it’s submitted, status updates must come directly from the MassHealth Premium Assistance team.
Processing the application typically takes 30–60 days. To help avoid delays, it’s a good idea to follow up with the Premium Assistance group a few days after submitting the application to make sure they received everything they need to make a determination. A quick follow-up call can make a big difference!

Premium Assistance Unit Contact Info:
🕐 Hours
• Mon–Tue: 8:00am–7:00pm (evenings often have shorter wait times!)
• Wed–Fri: 8:00am–5:00pm
📞 Phone: (800) 862-4840
📠 Fax: (617) 451-1332
📧 Email: MassPremAssistance@accenture.com
📬 Mail: 519 Somerville Ave #372, Somerville, MA 02143

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

17/02/2026

17/02/2026

https://umassmed.zoom.us/meeting/register/u6YUH74EQvWeg1JlfLiYow

12/02/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My daughter was approved for MassHealth CommonHealth and I received a premium bill. I also applied for Premium Assistance—do I still need to pay the invoice?

Thanks for your help!

Sincerely,
— A PA-tient Parent"

Hi PA-tient Parent!

Great question (and one we hear a lot).

Yes—until Premium Assistance (PA) is officially approved and applied, you’re still responsible for paying the MassHealth CommonHealth premium. MassHealth will continue to send monthly bills, and if premiums go unpaid for 60 days or more, coverage could be terminated.

Because the timing between applications can get tricky, we recommend contacting MassHealth Premium Billing if you have questions about your bill:
• 617-798-6827 (English)
• 617-798-6838 (Spanish)

If you want to check the status of your Premium Assistance application, you can call: 800-862-4840

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

12/02/2026

🎉 Joey’s Fund applications are OPEN!

Families across New England who have a loved one with an autism diagnosis can apply for financial assistance to help access meaningful supports and opportunities.
Funds may be used for things like:
• Camp tuition
• Recreational activities
• Therapies
• Safety equipment
…and more!

🗓 Apply by March 5, 2026 at 5:00 PM
📣 Award announcements: Late April 2026

Learn more & apply here:
https://flutiefoundation.org/helping-families/direct-financial-support/joeys-fund-hope-fund/

🌟 Applications are now OPEN for Joey’s Fund | Hope Fund, our Direct Family Support Grant!

Joey’s Fund and the Hope Fund exist to help families break through financial barriers and access the resources their loved ones with autism need to thrive and live life to the fullest.

From essential services and support, to classes, camps, and more, these grants are designed to meet families where they are and provide meaningful, life-enhancing assistance.

💙 Learn more about eligibility and submit your application:
https://flutiefoundation.org/helping-families/direct-financial-support/joeys-fund-hope-fund

Applications close March 5th at 5 PM ET.

05/02/2026

ASK THE INSURANCE GURU:

"Hi Guru,

My husband recently retired, and we received confirmation that our son, who had been on SSI, will now be receiving SSDI. Will this impact our son’s health insurance? His primary insurance is through my employer, with MassHealth Standard as secondary. What changes can we expect?

Transition Guardian"

Hi Transition Guardian,

What I can tell you is that nothing will change right away. Your son will continue to have your employer-sponsored insurance as his primary coverage and MassHealth as secondary. You will most likely receive a request from MassHealth for additional information to maintain his MassHealth coverage. You can always call the IRC for guidance on any MassHealth application you receive.

Another thing to keep in mind is that after receiving SSDI for 24 months, your son will automatically be enrolled in Medicare. If your employer-sponsored insurance is from a large employer (20 or more employees), then your plan will remain primary, Medicare will be secondary, and MassHealth will be tertiary.

Generally, once Medicare is issued, families assess whether they should maintain private coverage for their loved one. You will want to confirm whether your son’s providers accept Medicare and MassHealth. If he can continue seeing his providers with Medicare and MassHealth, there may no longer be a need to maintain private insurance.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

03/02/2026

https://umassmed.zoom.us/meeting/register/yOBQQD-1SDWVFP2fqymFwg

29/01/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I have a 4-year-old child who has been attending a center-based ABA program for the past year. We have been happy with our provider, but something happened last week that I am still concerned with. When I picked up my son, he had a raised welt on his cheek. The provider said they had no idea where the bruise came from. I asked the BCBA, and they said they would look into it, but they haven’t been able to tell me what actually happened.

I am still concerned about bringing my son back to the center. What should I do?"

I am very sorry that this happened, and you have every right to be concerned. I hope your son is okay.

First of all, you have every right to have the provider explain what happened. The reality is that while a child is in an ABA program, they should be with a technician or BCBA for the entirety of the time they are receiving treatment. So, I do think you have cause for concern if they don’t know what happened. I would suggest that you ask for a meeting with the provider and ensure they have an answer as to what happened, and what they will do to prevent anything like this happening again.

Secondly, you should know that you can contact the Department of Children and Families (DCF). The number for the Child-at-Risk-Hotline is 800-792-5200. You can call to report your concerns. For additional resources, you can find information for your local DCF office here.

Finally, you have the option of reporting this to your health insurance company to let them know you have a complaint against one of the providers in their network. The Health plan can document your account of the situation and this may result in further investigation.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

22/01/2026

ASK THE INSURANCE GURU:

"Dear Guru:

My patient’s insurance recently changed, and the new insurance requires that I provide a copy of the child’s Individual Education Plan (IEP). I am not sure I should be sharing this. Can you advise?

ABA provider"

Dear ABA Provider – This is a very concerning requirement.

The IEP is subject to a Federal Law, The Family Educational Rights and Privacy Act (FERPA). Submitting the IEP to insurance would be a violation of FERPA.
In many cases, it’s helpful for families to share a copy of the IEP with their ABA provider to help develop and coordinate a treatment plan. But sharing the IEP does not give you, as the provider, permission to submit it to insurance.

As part of the authorization review, an insurer can request information about school services, but they should not be requiring a copy of the IEP. I would explain to them that you are not able to share the IEP, and if this prevents you from getting an authorization, please reach out to my colleagues at the Insurance Resource Center for advice.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

20/01/2026

https://umassmed.zoom.us/meeting/register/-rv_MEf-QReeVIv10fVfSA

15/01/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I am a provider working with a family who could really benefit from your services, but the family does not speak English. Are you able to help families who speak other languages?"

Dear Provider,

Yes, absolutely! We are happy to support families whose first language is not English, and we can assist families of all language backgrounds. We have a Spanish speaking staff member who can work directly with Spanish speaking families. For families who speak other languages, we use a professional language line that gives us access to interpreters in over 240 spoken languages, including video conferencing to accommodate American Sign Language.

We also translate many of our written materials. Our fact sheets on varying insurance topics are available in multiple languages, including Spanish, Vietnamese, Portuguese, Simplified Chinese, and Haitian Creole. These can be a great resource for families and providers. You can find all of our translated fact sheets on our website at https://massairc.org/fact-sheets/ -content.

Language should never be a barrier to getting help. We are committed to meeting families where they are and ensuring they can access the support they need.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

08/01/2026

ASK THE INSURANCE GURU:

"Hi Guru,

Does someone need to have an autism diagnosis to get assistance from the Insurance Resource Center, or can they help other people who have insurance questions?

Thank you!

Provider A"

Hi Provider A,

Thank you for reaching out. The Insurance Resource Center’s (IRC) focus is to help people with insurance issues related to autism and behavioral health. That being said, they do not turn people away who don’t have a specific autism (or any other) diagnosis.

For people seeking assistance with MassHealth secondary insurance, they provide information and guidance per their attached Fact Sheet. And for people who have questions about cost/benefit of MassHealth secondary insurance they are able to help them analyze what the estimated premium might be, whether they will be eligible for Premium Assistance, etc. But as a rule, we don’t provide direct application assistance, except in rare circumstances. When families require or need direct application assistance, they usually refer them to MassHealth and/or Certified Application Counselors or other resources that can assist them in completing the application.

Please continue to refer families to the IRC, with the understanding that they are a small center and not able to provide step-by-step direct application assistance.

(Though this Fact Sheet does include them: https://massairc.org/wpcontent/uploads/2025/03/CommonHealth.pdf.)

And note that, if they are seeking in-depth application assistance they may refer them to other resources.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.