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Each coverage mandate in Michigan added 4% to insurance premium costs, according to a 2013 estimate. However, Michigan's autism coverage mandate was so extensive, the average has likely increased.
PANS and PANDAS have standard medical diagnostic criteria, billing codes, and treatment.
However, many (MANY) parents relate PANS and PANDAS to vaccines, and seek alternative treatments.
In 2019, the US HHS denied request for rulemaking under NVIC (National Vaccine Injury Compensation) for PANS and PANDAS, among other diagnoses commonly associated with vaccines.
Care impact:
Under this bill, coverage would be limited to standard care, which is unlikely to satisfy many parents.
Financial bottom line:
Like the existing list of 35 or so required coverage items, this new mandate would impact all plans sold in Michigan. It represents a shift for an indeterminate number of patients from Medicaid/last resort to private insurance coverage, and will certainly drive up premiums.
Wednesday, December 3, 2025 1:30 p.m.
AGENDA
SB 447 Sen. Hertel
Insurance: insurers; coverage for certain pediatric autoimmune neuropsychiatric disorders; require.And any other business properly before the committee.
I know someone whose daughter was diagnosed with PANS and PANDAS a couple of years ago following some type of illness. They do telehealth with a specialist out of state for treatment/therapy recommendations and it's covered by our insurance at work. That might be unusual though.
The specialist they see says that certain illnesses can trigger PANS and PANDAs in some children.
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