First Name
Last Name
Email Address
Phone number
Zip code
State
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Age of Child
Does your child have an ASD diagnosis or evaluation?
Select
Yes
No
Does your child have health insurance?
Select
Yes
No
Name of insurance provider
Select
AARP
Aetna
Aetna Better Health
American Family Insurance
American National Insurance Company
Amerigroup
Anthem
Beacon
Blue Cross
Blue Cross and Blue Shield Association
Blue Cross Blue Shield
California Physicians Service
Cambia Health Solutions
Carefirst Inc.
Caresource
Centene Corp
Centene Corporation
Cigna Health
Community First Health Plans Star Kids
ComPsych
Coordinated Care
Coventry Health Care
CVS
Driscoll
EmblemHealth
Evernorth
First Care
Fortis
Forward Health
Geisinger
Golden Rule Insurance Company
Group Health Cooperative
Group Health Incorporated
Guidewell Mutual Holding
Harvard Pilgrim Health Care
Health Care Service Corporation (HCSC)
Health Net
HealthMarkets
HealthPartners
HealthSpring
Highmark
Horace Mann Educators Corporation
Horizon Blue (BCBS NJ)
Humana
Humana MCal
Independence Blue Cross
Independence Health Group Inc.
Kaiser Permanente
Kaiser Permanente MCO CA
Kaleida Health
Liberty Medical
Magellan
MassHealth
Medi-Cal State of California
Medicaid
Medical Mutual of Ohio
MEGA Life and Health Insurance
Metropolitan
Molina Healthcare
MassHealth
Optum
Oscar Health
Oxford Health Plans
Pacific Source
Peach State Health plan
Point32Health
Premera Blue Cross
Principal Financial Group
Shelter Insurance
State Farm
Sunshine Health
Superior
Texas Star
Thrivent Financial for Lutherans
Tricare
UMR
UnitedHealth Group
Unitrin
Universal American Corporation
UPMC Health System
Utah Department of Health Medicaid
Wellcare
Other
Type of Insurance
Select
Commercial
State Medicaid
Managed Care Organization (MCO)
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