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Will Insurance Cover My Weighted Blanket?

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In this article, we will outline the economic aspects of weighted blankets, as regarding insurance covers. Please note that insurance plans may differ significantly between countries.

The prices of weighted blankets, just like the price of many medical devices, are not fixed. Prices of weighted blankets vary widely.

Prices are affected by a range of factors including the manufacturer, the material of the blankets, their size and weight, and whether or not they are made to custom specifications.

Weighted blankets made with cotton, for instance, are not priced the same as those made with flannel fabric or the plush mink fabric.

While the average price of a weighted blanket may not be considered pricey to some, it is quite the opposite with many others.

You might be wondering whether or not weighted blankets are covered by healthcare insurance plans. However, the answer is not as straightforward as the question. Weighted blankets are classified as medical devices, and as such, they are subject to the insurance legislation governing the country where they are purchased.

What are weighted blankets?

Weighted blankets are like normal blankets but with plastic-pellet or glass-bead weights embedded in them. They are an offshoot of research into physical therapy-based methods of alleviating certain symptoms of autism.

Heavier than normal blankets, they weigh down the user, otherwise known as ‘grounding,’ giving the same feeling as a hug or a gentle squeeze, activating the deep pressure touch zones.

This process triggers the release of endorphins (the body’s “feel good” hormones) and serotonin with a simultaneous decrease in cortisol, the body’s stress hormone.

Since this successful employment of weighted blankets for sensory integration therapy in autism, research has sought to explore other uses of weighted blankets in other conditions.

Quick side note: After conducting extensive reviews, my recommended weighted blanket is Quility which can be found on Amazon. I prefer this particular model available in both adult and child sizing.

What are they used for?

They have now been used in the management of patients with autism, anxiety disorder, insomnia, ADHD, fibromyalgia, night terrors, and a host of other conditions. It can also be used for conventional stress relief.

Different studies, reported in the Journal of Sleep Medicine and Disorders, the Journal of Medical and Biological Engineering and so many other peer-reviewed journals have attested to the usefulness of weighted blankets in these conditions.

What constitutes medical insurance in the USA?

Medical insurance is a kind of insurance that pays for the medical and surgical bills an insured person incurs. Insurance companies can either pay the hospital directly or refund the insured for payments he has already made.

The Affordable Care Act stipulates a list of services that health insurance plans MUST cover. The essential health benefits are:

  • Emergency services
  • Hospitalization charges
  • Ambulatory services (treatment at home or outside the hospital)
  • Pregnancy, maternity, and childbirth-related costs.
  • Mental health services (including the costs associated with counseling and psychological therapy)
  • Prescription drugs
  • Rehabilitative and Habilitative services and devices (these include devices and services that assist one in regaining certain mental and physical skills and helping them cope in the interim)
  • Laboratory services
  • Preventive and Wellness services
  • Pediatric services (including dental care and visits to the optometrist for kids)

Does the Affordable care act differ between states?

Yes, it does. All states offer these same benefits while some states mandate even more services to be included on the list.

Different healthcare insurance plans on the market also have different additional coverage that makes them more attractive and competitive.

It is very important to be aware of the range of services an insurance plan offers before committing to it.

What is not covered?

While different healthcare insurers can include extra services covered to increase their competitiveness in the market, some services are generally not covered. These services and purchases include:

  1. Travel vaccines
  2. Cosmetic surgery
  3. Acupuncture and similar practices
  4. Non-prescription medicine
  5. Weight loss surgery
  6. Preventative tests
  7. Dental care for adults
  8. Nursing home care

Is there a limit?

According to the U.S Department of Health and Human Services, while there are annual and lifetime limits to how much insurance companies can pay, there is no annual or lifetime limit to healthcare insurance.

This, however, only applies to what the Affordable Care Act (ACA) considers “Essential Healthcare Benefits” (which we have itemized in this article).

If the service is not among those services which the ACA mandates must be covered, healthcare insurers can put annual and lifetime caps on how much spent on them can be refunded. More information about the limits can be found here.

Are Weighted blankets covered by medical insurance?

With this information about the services covered by health care insurance in the U.S., we can see that rehabilitative and habilitative services and devices, preventative and wellness services, prescription drugs and mental health services make the list.

While the interpretation of what is a prescription drug cannot be skirted, the definitions of what makes up other services listed are subject to multiple interpretations.

Weighted blankets are surely important as habilitative devices for patients suffering from severe anxiety; they have also been used in several mental illnesses such as autism, sensory processing disorder, attention deficit hyperactivity disorder, and even depression.

Weighted blankets can also be construed as a ‘wellness device’ owing to its application in the relief of stress which can, if left unchecked, lead to a breakdown in mental health. But while they can be classified as medical devices, they cannot be classified as prescription drugs.

This is the reason for the ambivalence among healthcare insurance providers about whether or not to cover weighted blankets.

So, what steps must you then take to protect your investment?

Steps to take

Firstly, it is important to speak with your insurance company to ascertain whether or not they have coverage for weighted blankets.

Fortunately, some healthcare insurance providers have accepted weighted blankets as medical devices and now cover them. Some insurance companies have policies that stipulate that there is no coverage for weighted blankets.

While a one-time purchase of a weighted blanket off insurance for an adult might not be a significant investment, the same is not the case for kids, who grow quite rapidly and may need to change their weighted blankets more frequently.

It is therefore important, especially for kids with special needs, to have a health care insurance plan that covers weighted blankets.

Some insurers also have coverage for weighted blankets below a certain price. This is similar to what some medical insurance companies do with regard to some prescription drugs.

An insurance company might refuse to reimburse the buyer when there is a cheap and equally effective alternative the insurance owner ignores in buying the more expensive brand.

Consult your insurance provider

It is therefore important to inquire from the insurance providers about the brands they are willing to reimburse purchases of and whether they have a ceiling on what the cost of the blankets should be.

Secondly, it is equally important to speak with your healthcare specialist; in many cases a doctor or Physiotherapist.

Certain healthcare insurance companies, like Medicaid (which is a state-controlled health insurance program), attend to reimbursement claims on a case-by-case basis.

Get a prescription from qualified medical personnel

A prescription for weighted blankets by your medical doctor or your child’s pediatrician will go a long way in making sure you get reimbursed for the cost of your purchase.

Many doctors are still unaware about the medical benefits of weighted blankets. To qualify for an insurance cover for an item like a weighted blanket, your doctor will need to do due diligence by combing literature for studies that establish the benefits of weighted blankets in the condition you or your child are being treated for.

Earlier in this article, we have discussed the science behind weighted blankets and cited some peer-review articles that study the medical claims of weighted blanket manufacturers.

If you need to buy a weighted blanket and don’t have the money at the time, you can have a medical supplies agency provide you the weighted blanket and use the invoice to bill your insurance provider.

This option has gained a lot of popularity among users of weighted blankets. It eliminates the need to haggle with your healthcare insurance providers and increases the timeliness of your purchase.

Alternatively, you can make an outright purchase for a weighted blanket and subsequently present your invoice to your insurance company for reimbursement.

Last Words

Weighted blankets are important medical devices with applications in the management of several mental conditions and the relief of stress in both children and adults. Many studies have established the usefulness of weighted blankets in the management of these conditions.

A growing number of physical therapists are beginning to see the need to recommend and prescribe weighted blankets to their clients. However, certain health care insurance companies do not yet have coverage for weighted blankets.

It’s important to consult the respective healthcare insurance providers to ascertain whether or not they have coverage for weighted blankets and speak with your prescriber over the possibility of writing prescriptions for them for you or your loved one.

As more and more studies of the usefulness of weighted blankets continue to emerge, they should make their way into more coverage lists.

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P.S. Quility is my #1 choice for weighted blankets and can be found on Amazon. I recommend this particular model available in both adult and child sizing.