It's that time of year again—Open Enrollment season. And if you're parenting a neurodiverse child, you already know that choosing the right healthcare plan isn't just about comparing premiums and copays.
It's about making sure your child has access to the care they actually need—whether that's occupational therapy, a developmental pediatrician who listens, probiotics for gut health, or someone who doesn't dismiss your concerns at every visit.
In this week's episode of The Parenting Cipher, I sat down with Dr. Timothy McKnight—a retired pediatrician with 15-20 years in pediatric emergency medicine and current Executive Director of Cleveland State University's Pathways to Practice program. We got real about what it takes to show up to the doctor's office prepared, advocate effectively, and navigate a healthcare system that doesn't always see us.
Dr. McKnight said something that stuck with me:
"Eighty percent of the time, you can get the diagnosis based on history before you even touch the patient. You need to get the story right."
And I realized—this applies to everything, including how you choose your health insurance during Open Enrollment.
Because when you know what coverage your child needs, you can tell the right story to insurance companies, doctors, and specialists. You can advocate from a place of power, not panic.
So let's break it down.
Raising a child with ADHD, autism, sensory processing disorder, anxiety, or other neurodevelopmental differences often means you need access to a team of providers—not just one pediatrician.
Your child might need:
But here's the problem: Not every health plan makes accessing these services easy.
Some parents find out too late that their insurance:
And by the time you realize it? You're stuck for another year.
That's why Open Enrollment season is your moment to make empowered, informed choices.
Let's talk numbers for a second, because I know you're juggling a budget.
According to research, families of children with special healthcare needs spend 3-5 times more on medical care than families with typically developing children. That includes:
When you choose the wrong plan, those costs can skyrocket. But when you choose strategically? You can save thousands while getting better care.
Here are the exact questions I want you to ask when reviewing your options—whether through the ACA Marketplace, Medicaid, employer-sponsored insurance, or private plans:
✅ Is my child's current therapist or specialist in-network?
Don't assume they are. Call and verify. Get it in writing if possible.
✅ What specialists does this plan cover?
Specifically ask about: developmental pediatricians, pediatric gastroenterologists, neurologists, psychiatrists, psychologists, and behavioral therapists.
✅ Does this plan require referrals for specialists?
Some HMO plans require you to get permission from your primary care doctor first. This can delay urgent care.
✅ What's the process for getting a second opinion?
Dr. McKnight reminded us that mother's intuition matters. If you need a second opinion (and you have every right to one), make sure your plan covers it.
✅ Does this plan cover occupational therapy, speech therapy, physical therapy, and ABA?
Ask specifically about session limits. "Yes, we cover OT" might mean only 20 sessions per year.
✅ Is there a cap on mental health or behavioral therapy visits?
Federal law requires parity, but plans can still limit visits. Know your limits upfront.
✅ Are telehealth therapy sessions covered?
This is huge for working parents or rural families.
✅ What's the prescription drug formulary?
Check if ADHD medications, anxiety meds, or other prescriptions your child takes are covered—and at what tier (generic vs brand name).
✅ Does the plan cover nutritional supplements prescribed by a doctor?
Things like probiotics, fiber supplements, or specialized formulas might be covered if prescribed.
✅ What is the out-of-pocket maximum, and how close did we come to that last year?
If you hit the out-of-pocket max every year, a plan with a higher premium but lower max might save you money.
✅ What are the copays for therapy, specialist visits, and ER visits?
These add up fast. Do the math.
✅ Does the plan have a Health Savings Account (HSA) or Flexible Spending Account (FSA) option?
These let you use pre-tax dollars for medical expenses—a huge benefit.
✅ What hospitals and urgent care centers are in-network?
Dr. McKnight worked in pediatric ERs for years. Trust me—you want to know this before your child has a health crisis at 2 AM.
✅ Is there 24/7 nurse advice line access?
This can save you unnecessary ER trips and give you peace of mind.
Before you even start browsing plans, pause and look back at the past year.
Pull out your calendar, credit card statements, and medical records. Ask yourself:
📋 What types of appointments did we have this year?
Count therapy sessions, specialist visits, urgent care trips, ER visits, regular checkups.
💰 How much did we spend out-of-pocket?
Include copays, medications, evaluations, and anything insurance didn't cover.
🤔 What services do I wish we had access to?
Maybe you wanted to try feeding therapy, but your old plan didn't cover it.
😤 What frustrated us most about our current plan?
Long wait times for referrals? Denied claims? Out-of-network specialists?
This step matters because it tells you what kind of coverage your actual child needs—not just what looks good on paper.
As Dr. McKnight emphasized in our conversation, documentation is everything. He told parents:
"Get a little notebook to document their signs and symptoms. Make a diary. This creates the story for the doctor as to what's going on."
The same principle applies to choosing insurance. When you document your child's actual healthcare usage, you make smarter decisions.
Use the free Child Health Symptom Tracker I created based on Dr. McKnight's advice. It's:
One of the most powerful parts of my conversation with Dr. McKnight was his emphasis on parental advocacy—and how it starts before you even get to the doctor's office.
Dr. McKnight shared a story that gave me chills. He talked about mothers who brought their children to the ER multiple times, insisting something was wrong—only to be dismissed by doctors who thought they were "overreacting."
He said:
"I always listen to that mother's intuition. I've seen a lot of doctors get burned by dismissing it."
He went on to share examples of children who had serious conditions like meningitis that were initially missed because providers didn't take the parent seriously.
This is why having the right insurance coverage matters. When you're advocating for your child and a doctor dismisses you, you need the freedom to:
Dr. McKnight gave us a practical toolkit for doctor visits that every parent should use:
📝 Keep a health journal (notebook or voice notes on your phone)
🌡️ Stock your medicine cabinet: Motrin, Tylenol, functioning thermometer
📊 Track these details:
He explained:
"This will create the story for the doctor as to what's going on and how that disease is progressing. You don't have to tell that story over and over again. You've got documentation, and you're prepared to speak at a high level."
When you apply this same strategy to choosing your healthcare plan, you're not just saving money—you're protecting your child's ability to thrive.
One of the biggest revelations from my conversation with Dr. McKnight was about gut health and neurodiverse kids.
My son has autism and sensory processing disorder. He's a picky eater, struggles with constipation, and we've ended up in the ER because of severe stomach pain that doctors initially dismissed.
Dr. McKnight validated everything I've experienced:
"A lot of kids don't want to eat their fruits and vegetables. Getting them to eat a balanced diet with adequate amounts of fiber is a big challenge."
He went on to explain that for neurodiverse children:
He even developed a line of pediatric wellness products (available at McKnightMD.com) specifically to address these gaps—including:
When choosing your health plan, ask:
These services can make a massive difference in your child's daily functioning—but not every plan covers them.
Dr. McKnight didn't hold back when we talked about the reality of being a Black family navigating healthcare.
I shared my own experience of feeling dismissed in the ER:
"Sometimes I feel like because of my color, you're not taking me seriously. You're not taking my child seriously."
Dr. McKnight acknowledged this reality and shared his father's story—a 1945 Howard Medical School graduate who practiced medicine at a time when Black doctors couldn't touch white patients and were barred from most hospitals.
Today, Black physicians make up only 5% of practicing doctors. In dentistry, it's even worse—3.8%.
When choosing a health plan, consider:
Dr. McKnight now runs the Pathways to Practice program at Cleveland State University, which is working to change these statistics by supporting underrepresented minorities into medical school.
Representation in healthcare saves lives. When our children see doctors who look like them, trust increases—and so does the quality of care.
Some health plans offer features that can make a huge difference for families like ours—but they're buried in the fine print:
Someone who helps you:
Coverage for:
For older kids and teens:
Coverage for:
Some plans offer:
Ask if these are covered—and how often. Because a "yes" doesn't always mean unlimited access.
I know not everyone has multiple plan options or the budget for premium coverage. If you're on Medicaid, have limited employer options, or are working with tight finances, here's what you can do:
Focus on finding:
You don't need the most expensive plan to get good care—but you do need to be strategic and persistent.
Ready to make this Open Enrollment season your most empowered yet? Here's your step-by-step plan:
Healthcare isn't one-size-fits-all—especially when you're raising a neurodiverse child.
You deserve a plan that:
Open Enrollment is your opportunity to take back that power.
As Dr. McKnight reminded me:
"You have to listen to that intuition. I've seen a lot of doctors get burned by dismissing it."
Trust yourself. Trust your instincts about what your child needs. And choose a healthcare plan that supports—not hinders—your ability to advocate fiercely for your child's wellbeing.
And remember—you're not alone. I'm here with resources, checklists, podcast episodes, and a community that reminds you: You've got this.
📥 Child Health Symptom Tracker for Doctor Visits - Based on Dr. McKnight's advice
📥 Medical Advocacy Letter Templates - 8 customizable templates for every situation
📥 Open Enrollment Comparison Worksheet - Compare plans side-by-side
📥 IEP Mastery Freebie - Connect school and health services
🎧 Listen to the Full Episode with Dr. Timothy McKnight
📺 Watch on YouTube
📱 Follow on Instagram for Daily Tips
🛒 McKnightMD.com - Dr. McKnight's line of probiotics, fiber gummies, multivitamins, and sleep support for kids
💬 Join The Parenting Cipher Community
📧 Subscribe to the Newsletter
📞 Book a 1:1 Advocacy Coaching Call
What's your biggest Open Enrollment question or concern? Drop a comment below—I read every single one and often create content based on your questions.
And if this post helped you, please share it with another parent who's trying to figure out healthcare coverage for their neurodiverse child. We're stronger together.