Comments on: What’s Medically Necessary?

By: Maybe Things Do Change

Maybe Things Do Change — Mon, 14 Jul 2008 19:12:16 +0000

[...] I may step back a bit and reflect on how many states have sought to pass legislation to provide insurance coverage for autism therapies, I think back to 1999 when Charlie had just been [...]

By: Kristina Chew, PhD

Kristina Chew, PhD — Mon, 14 Jul 2008 02:55:08 +0000

Earlier on Sunday, Illinois governor Rod Blagojevich announced an amendatory veto to a bill that has gotten stalled in the state legislature. According to ABC local news, the governor has rewritten the bill so that

insurance companies will have to cover up to $36,000 per year for treatment like speech and occupational therapies for children with autism, therapies that not everyone can afford. "Because I've gone out-of-pocket almost $80,000, my daughter can speak. Every kid should have access to this, not just the privileged," said Peter Dicianni, father of a child with autism.

By: Last Week’s Top Posts

Last Week’s Top Posts — Sun, 13 Jul 2008 22:13:16 +0000

[...] What’s Medically Necessary? Parents, insurers, schools, who pays? [...]

By: Guillermo Arce

Guillermo Arce — Thu, 10 Jul 2008 00:10:22 +0000

I can tell you, as the parent of the child featured in the L.A. Times article. The therapies that my insurance co. was forced to provide are helping. How long will it take? Only time will tell. However, I am for the basics (ABA, OT, Speech), not the flavor of the month therapies that are around.

By: Lisa Rudy

Lisa Rudy — Tue, 08 Jul 2008 14:42:58 +0000

On my blog, I’ve received several comments about this article which suggest “it’s better to pay now for ABA than to pay later for institutional living.” The implication, of course, is that by providing ABA now, you are guaranteeing that the child will develop the skills and abilities to live on his/her own forever after.

Truth is – there’s no reearch to support that idea. The prior poster who noted that there’s no good definition of “successful” treatment is absolutely right! Hopefully we can actually look at longterm outcomes soon – and get a better sense of what works not just for educationally mainstreaming kids but for preparing them for adult life.

Meanwhile, on a related issue – a prior poster noted that there are many kinds of ABA. Boy, is that true! After interviewing many ABA providers for articles on my site, I realize that there is an ENORMOUS difference between the typical discrete trials program and a truly creative, energetic, child-focused ABA program.

As is so often the case, I’m afraid we are often comparing apples (DT) to oranges (high quality ABA)!

Lisa (www.autism.about.com)

By: Joeymom

Joeymom — Tue, 08 Jul 2008 00:39:14 +0000

Farmwifetwo: I am glad what works for you is working for you. However, I have a real problem with people who insist that their way is the only way, and that therapies that work for their kids are the only therapies necessary for other children.

My Joey hasn’t required intensive ABA. Well and good. But it has been a lifesaver for several families we know. It hasn’t worked at all for several families we know. That’s autism for you. Speech therapy and OT has done little for several families we know, too.

The fact is, many insurance companies see “autism” and deny everything, including working therapies. It becomes a coding game, a semantics game, a game of hot potato- because the schools tell you these are medical therapies, and the insurance is saying they are educational.

By: farmwifetwo

farmwifetwo — Tue, 08 Jul 2008 00:07:13 +0000

When they give money for THERAPY (like private OT and speech) of someone’s choosing not just ABA and whatever other therapy is the “flavour of the month”, then I’ll be for it.

In the meantime I’ve discovered that in our home, good parenting beats ABA hands down in teaching proper behaviour and self-help skills. And sitting down and reading, printing, doing math and making it fun and interesting… teaches the 3R’s just fine.

Now… if someone was willing to pay for our private speech therapy, that would be nice.

By: Joeymom

Joeymom — Mon, 07 Jul 2008 23:13:12 +0000

This isn’t just an ABA issue. Many insurance companies also won’t cover occupational therapies, speech therapy, or physical therapy, because it’s an “educational issue.” Now, mind you, they cover these things if their need results from “illness, injury, or birth defect.” If he had, say, cerebral palsy, then speech, OT, and PT is covered, no problem (cerebral palsy is considered a birth defect by our insurance). But since we don’t know what causes autism, we’re out of luck.

Well, we were, until my husband took a job because the insurance was out of Maryland, which requires insurance to cover services for autism.

By: Teri

Teri — Mon, 07 Jul 2008 23:09:52 +0000

I still laugh (kinda)–the ins. co. we had when our son was first diagnosed paid for 2-1 hr. sessions of SLT/wk (which is the best thing that ever happened to him!). My husband’s company changed insurance after about 18 mos., and although the new contract had verbatim wording re: SLT, they would not pay (!) because it was not rehabilitative: he had never had speech to begin with (as far as they were concerned). I should have fought more to get coverage to recover the 18 words or so that he DID have early on in his verbal career! Ha!

By: Kristina Chew, PhD

Kristina Chew, PhD — Mon, 07 Jul 2008 20:48:53 +0000

Yes, fulling funding IDEA—–and that sentence about self-destructive behaviors also stood out to me. Charlie was once in danger of doing serious damage to himself —- treatment had to come from many sources and all of it was necessary.