Insurance Doesn’t Pay For Groceries—What About Autism?
Two comments by officials in two Utah insurance companies suggest how much is still not known about autism. From today’s Salt Lake Tribune:
“Is it even a defined disease? It’s a heart-breaking condition, but they don’t know the etiology, they don’t know the source,” said SelectHealth’s Medical Director Ken Schaechar. Autism is one of five pervasive developmental disorders for which [the insurance company] doesn’t cover diagnosis or treatment.
Yes, autism is “defined”; here’s the DSM criteria. Those criteria are under revision but once you know what autism is, you become much more aware of how much autism there is around you. By providing children with the therapies they need, autism is not at all “heart-breaking”—-not when you hear your child speak and see them learn and grow. The second comment:
Regence BlueCross BlueShield of Utah covers autism diagnosis and treatments for associated problems like anxiety and depression, but it won’t cover therapies because autism can’t be cured, said spokeswoman Tauni Everett.
“We know that eating healthy improves our members’ health, but we don’t pay for groceries. This is really a similar situation,” she said.
Right, autism “can’t be cured” but those therapies can lead to children making real strides with severe communication and behavior problems that impede their ability to achieve their full potential. To say that providing autistic children with therapies is “a similar situation” to paying for groceries belittles the very real needs of autistic children and their families.
A call to New Jerseyans to attend a hearing about Assembly Bill 2238 just came into my Inbox. The bill calls for health insurers to cover certain autism-related therapies and treatment (applied behavioral analysis in particular). The hearing was scheduled at the last minute for Thursday, May 22, 2008 at 2:00pm at the Capitol in Trenton with the Assembly Appropriations Committee; I won’t be able to go (that’s “time to head home to meet Charlie at the bus time”).
But I don’t think those who show up equate what they are doing to shopping for groceries.
Tags: asd, asperger, autism, autism blog, funding, government, Health, Insurance, jersey blog, laws, Legislation, New Jersey, pdd-nos, Politics, Science, utahRelated Stories
POSTED IN: Insurance, New Jersey, Stereotypes
16 opinions for Insurance Doesn’t Pay For Groceries—What About Autism?
Emily
May 21, 2008 at 6:09 pm
This is why insurance companies CKMA. I’d like them to tell me exactly what causes breast cancer in women who don’t have a familial component. I bet they cover it, regardless. I bet they cover palliative care in some cases, even though the patient won’t be “cured.” I bet they cover maintenance doses of thyroid hormone for people with thyroid imbalances who will never be “cured.” I bet they cover disease-modifying drugs for multiple sclerosis even though no one has a real clue what causes it and no one will be “cured.” Genius logic they’ve got there.
Kristina Chew, PhD
May 21, 2008 at 6:24 pm
“Autism” is very “special,” it seems.
Marcie
May 21, 2008 at 6:42 pm
Louisiana is currently seeking to get ABA covered. I don’t know much about therapy but I think society needs to support families with autistic members better. So far, the bill has passed, with one or two steps to go. At some point, someone who was trying to dissuade the gov’t from approving the bill said that she too had to give up things since she had children - like buying designer handbags.
VAB
May 21, 2008 at 8:57 pm
Until you have single payer state health coverage, it’s not really going to get much better. The US is the world wealthiest country with the world’s poorest health coverage.
Regan
May 21, 2008 at 9:27 pm
“- like buying designer handbags.”
——————
Somebody didn’t actually say that, did she?
Because if so, that would be a major perspective disconnect.
I don’t want to get into the comparison game, especially relating to health, but there are chronic conditions which are covered, and there are conditions neurologic and “mental” which are covered, and there are expensive situations which are covered.
Some of this seems to be left over from the days when autism was considered “hopeless”, some of this has to do with some confusion over what constitutes best practices, although there have been reports aplenty, no shortage of neurology papers indicating that this is a neurologic condition and outcome studies that do show improved trajectories and even achievement of good outcomes. There are even some state or jurisdiction court cases involving insurance companies which state that some treatments are not experimental and do constitute appropriate treatments under the medical model.
The bottom line is $$ because insurance companies are businesses. That said, if a posited mandate is less costly than that covering many weakly evidenced treatments which have uncertain outcomes and high relapse rates, at the least it seems fair to allow these kids coverage. If the cost makes everyone crazy, put the cap at 10 or 12. It would cut us out (again), but I wouldn’t begrudge the little guys coverage that we didn’t get.
The thing that I always harp on is that even with a mandate passage, you can still have a substantial number of people cut out because of ERISA exemption (that bill is still in Congress and I notice that a few people are starting to perk up about it). Another angle is that if you are part of a self-insured, but reasonably well-heeled company is to see if there are enough similarly situated people to lobby the human resources department or board of directors to self-insure such coverage.
Kristina Chew, PhD
May 21, 2008 at 10:40 pm
Well, you can buy knock-offs of designed handbags but knock-offs of good autism treatment—not the same.
I still find the comparison with parents fighting for insurance coverage for children with anorexia instructive.
mayfly
May 22, 2008 at 12:29 am
While I agree that socialized medicine would help a lot — It won’t guarantee treatment for autism. For instance, there is a movement now to get ABA added to the benefits provided by the Canada’s health care system. Currently it is not.
Storkdok
May 22, 2008 at 5:54 am
Autism is still considered a “mental health” diagnosis, when it is obviously a neurological disorder, medically speaking. I am sure the insurance companies will continue to deny coverage or severely limit coverage on the basis of limiting “mental health” coverage, which they already do.
The excuse for not covering autism because “it can’t be cured” is ludicrous. There are many disorders that are covered by insurance that are not curable. They hide behind this excuse.
I suppose it will take more lawsuits and legislation to force the insurance companies to pay for these services. But they would probably go broke, so I don’t know that that will even help.
Practically speaking, I think we need a federal mandate on covering services to ensure at least a baseline of services being covered to equalize services between states. I hear all the time about people moving to this or that state to get better services for their children.
I am more concerned about the here and now services to prepare my son for adulthood. The government focus seems to be primarily on early diagnosis of autism and research as to the cause, and that is important, but the government seems to forget the kids once they get the diagnosis, and especially once they become adults.
Jen
May 22, 2008 at 7:29 am
With regards to Universal Health Care coverage, we currently live in Ontario, which theoretically covers ABA therapy. When our child was diagnosed, we were told that the estimated wait time was 18 months to two years. Needless to say, we’ve sought out other alternatives…
Jane Sondern
May 22, 2008 at 9:18 am
Diabetes is not curable. But we all know that with proper diet and insulin, a diabetic can manage the disease. We know that autism is not curable. What I want for my child is for her to go as far as her potential allows her to, and how to live with autism.
Mrs. C
May 22, 2008 at 12:34 pm
LOL Jane, I was just going to mention diabetes!!
I *hate* how autism is a “mental health” issue. It severely limits your coverage- we have NONE.
Then again, I look at “mental health” issues in a different way now that we are dealing with autism. What would it be like to be bipolar or depressed and not get covered because insurance thinks that if you’re just “nuts” it’s all in your head? These are antiquated thoughts, just like the idea that LASIK is an “experimental” treatment LOL! Less money out of their pockets, I suppose, is what it must come down to.
But how stigmatizing and difficult for those of us working and caring for folks with autism, etc.
Moi
May 22, 2008 at 10:16 pm
PA’s autism waiver (Medicaid) just passed. Anyone wanting to move here, well, come on down!!! You have to be enrolled before you are 18, though, from what I understand.
Moi
May 22, 2008 at 10:17 pm
Ooops, clicked Send too soon…
The article is on the link on my name…
And adults will be covered now, I believe - the 18 yo thing is for the kids coming up. The requirement would be that you would have to have the Dx before you turn 18 and then register with the DPW to get the insurance before that.
Joeymom
May 24, 2008 at 12:50 am
Gotta love insurance. No matter what laws you pass requiring coverage, don’t forget that small business insurance will be exempt from those requirements. Heaven forbid you be unemployed.
We had insurance that wouldn’t cover if you mentioned “autism” anywhere in the paperwork (including normal well child visits), but were happy to cover speech therapy for apraxia, or OT for dyspraxia. It often comes down to semantics, because after all, insurance is about making money, not paying it out.
that wouldn’t be too bad, expect that part of that “not paying it out” is negotiating price. Private pay can be two, three, ten times more than what the insurance will pay; but if they won’t cover it, they also won’t negotiate the price for you. You are simply a private pay client. Paying full price.
Kristina Chew, PhD
May 24, 2008 at 10:51 am
It felt revolutionary when we switched insurance providers and suddenly the co-pays for office visits and medication went from $20 to $5 and sometimes $2. A huge difference.
Jennifer
Jun 7, 2008 at 9:12 pm
I have a 3 1/2 year old daughter with autism. I have been told that she needs specialized therapy (ABA) to make the biggest impact on her. My child is extremely bright and a quick learner and with the appropriate tx, she could probably make great strides. I pay $750 per month for health insurance plus an extra $120 per week for at home therapy and am unable to afford the over $40,000 per year therapy that she truly needs. I think that someone who lives with someone with autism should be voting to pass this law because there would be no discussion of what the outcome would be. The people with autism would be getting what they need, no questions asked.
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