Paying the Bills: Seeking Insurance Coverage in Missouri
April 15, 2008 by Kristina Chew, PhD
Filed under California, Insurance, Money, New Jersey, Parenting, Treatment
The April 14th St. Louis Post-Dispatch makes a case for the need for insurance coverage for autism treatment. SB 1122 would allow for insurance coverage “for the treatment of autism under certain conditions”: Autistic children who are “less than 16 years of age” would qualify for up to $50,000 per year of behavior therapy. St. Louis Post-Dispatch notes that one family, Molly and Steve Schad whose 7-year-old son Harry is autistic, have spent about $60,000 in treatments over the past 5 years. They have refinanced their home “several times,” borrowed from Molly Schad’s parents, and may have to sell her engagement ring.
Dr. Wayne Meyer, medical director of Anthem Blue Cross Blue Shield of Missouri, is interviewed:
…….Studies that show benefit from these therapies have flaws, Meyer said. He doesn’t see enough research that show more intensive therapies working better than less intensive ones.
Still he understands parents’ frustration. “If I had a child with this, I might feel the same way,” Meyer said.
“If we could, we’d pay for everything,” he said. “We’re paying for what we can.”
I can’t of course speak for Meyer, but I kind of suspect that most parents of autistic children do feel they have to do everything they can to help their child do the best she or he can, whatever it costs and the general effect on one’s finances and income.
Here’s a Missouri Autism Legislation Overview by G. K. Luetkemeyer, who includes a list of all the Missouri bills concerning autism. And here’s more about autism legislation in some other states:
- Florida
- Arizona
- California
- Wisconsin
- New Jersey
- Oklahoma
- Colorado 9and Gov. Bill Ritter signed SB 163 into law on April 14, to establish a 24-member Colorado Autism Commission)
Jeff Stimpson
Jill Cornfield
“Studies that show benefit from these therapies have flaws, Meyer said. He doesn’t see enough research that show more intensive therapies working better than less intensive ones.”
True, but so? You know, Lisa Jo Rudy of autism about.com made this really great comment on her autism podcast interview that with the really good, experienced therapists it didn’t matter what the label on the program was, they were all the same and that included Floortime, TEACCH, ABA and RDI (which I tend to think not very highly of). The thing they could all do was set up a working dialogue of meaningful communication. They connected to the kids and the kids responded accordingly. I suppose the trick is to snag the really good therapists:)
I think the major problem is that children do respond differently with treatments. Both of my children had ABA for 1.5 years but my younger son thrived under the treatment while my older son made modest gains. I know of one child that was mainstreamed under floor therapy. It is very difficult to convince politicians to fund expensive therapy when they hear stories of children doing well under the less expensive treatments. Personally, I would like to get to the point that we can try a variety of treatments that work best for our children without having to worry about funding nor waiting in line for treatments.
I also think that a good therapist and teacher, whatever they say they do, is actually drawing from the whole alphabet soup of therapies. ABA and DTT and Floortime techniques are sort of what one naturally does to coax a child to play, and throw in some speech and some sensory reinforcement……
The problem with this sort of legislation, although well intentioned, is that it raises insurance costs for everyone. Given how difficult it is for many people to afford health insurance currently, once everyone lobbies for mandatory and expensive benefits for their own specific conditions then the cost of health insurance becomes even more prohibitive. Furthermore, Legislatures cannot distinguish between good and bad medicine and you have situations like the UK’s National Health Service paying for homeopathy. Some state legislature could just as easily mandate coverage for chelation or hyperbaric oxygen therapy.
We have a good healthcare plan and it covers no where near 50K a year of treatment for our son. We get something like 20 sessions each of occupational, speech and physical therapy.
Actually, here in Ohio, I spoke to my congressman about the costs and the insurance would not increase very much at all. The debate here is whether education should fund it or insurance. Also, if the autism parity bill does pass, it only covers certain private health care providers and those on medicaid will not be covered.
Usually the bills specify the coverage, and if they don’t, the legislature and insurance divisions step in to cost-control. The estimate is <1% increase of the cost per policy (and this is from an insurance industry lobbying organization)–about a latte per month.
It is the case that usually there are specifications and exemptions–such as companies that are self-insured or that fewer than x employees (one yardstick is 50). I believe that they also can’t mandate coverage if the insurance company is out of state. It really depends on what the bill states and how it changes in amendment.
For instance-some bills have started out asking for a broad coverage and end up with expanded speech, OT and Physical Therapy. Others have started out asking for coverage and ended up passing as appointment of a task force with no change to insurance. Quite a few don’t pass or die in committee. Some of the bills and laws have review periods written in.
I don’t know if I completely buy the anything as long as the therapist is good argument, but it is certainly true that a lousy implementation can be extremely cost ineffective no matter what the name. For the educational treatments, at least in the bills that I have read, there is supposed to be oversight by a licensed psychologist and periodic review of progress. I think in the case of treatments which have a psychological basis that one could examine and perhaps forward the report of Chambliss, et al. of what the APA considers sufficient evidence to consider something an empirically based treatment.