[jetti]

"They want most people paying in to need little or nothing from them."

Exactly. I'm not conveying my thoughts very well. The way it is setup would allow people to treat the autism diagnosis exam as preventative care. If they know they don't have autism or suspect they don't, they can go get the exam done and insurance will cover it, even though there may have never been a valid reason for that person to take the exam. Granted, this isn't going to be something that many people (if anybody) would do for fun or to make the insurance company suffer, but it is an option the way they have it setup. I hope that makes more sense on my end.

[Mz]

The insurance company is well aware that few people will seek such an exam unless they have reason to suspect they have a problem. It is similar to the idea that you don't want to sell insurance specifically and only to cover pregnancy. Any woman looking to sign up for such coverage is extremely likely to be planning on getting pregnant.

Insurance is about risk management. In order to have "risk" there has to be chance. A lot of human behaviors are a choice, not a random roll of the dice. The insurance company is well acquainted with that fact.

I understand your framing, but, no, it doesn't really work that way. You just aren't going to have enough people who are sure they do not have autism decide to get tested for it for it to be a serious risk for the company. Their current policy covers their ass: if you get tested to confirm your diagnosis, you get to pay for the test and, apparently, volunteer to pay out of pocket for any further treatment related to your new diagnosis. They can merrily claim to cover the test if you do not need it because, in practice, the odds are really poor you won't get it if you do not need it.

I hope that is a little clearer from my end.