Comments on: Insurance Doesn’t Pay For Groceries—What About Autism?

By: Jennifer

Jennifer — Sun, 08 Jun 2008 01:12:32 +0000

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.

By: Kristina Chew, PhD

Kristina Chew, PhD — Sat, 24 May 2008 14:51:34 +0000

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.

By: Joeymom

Joeymom — Sat, 24 May 2008 04:50:17 +0000

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.

By: Moi

Moi — Fri, 23 May 2008 02:17:38 +0000

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.

By: Moi

Moi — Fri, 23 May 2008 02:16:06 +0000

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.

By: Mrs. C

Mrs. C — Thu, 22 May 2008 16:34:15 +0000

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.

By: Jane Sondern

Jane Sondern — Thu, 22 May 2008 13:18:53 +0000

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.

By: Jen

Jen — Thu, 22 May 2008 11:29:04 +0000

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…

By: Storkdok

Storkdok — Thu, 22 May 2008 09:54:32 +0000

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.

By: mayfly

mayfly — Thu, 22 May 2008 04:29:53 +0000

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.