Friday, July 11, 2008

Pennsylvania Leads the Way, California, Step Up!

All eyes are watching Pennsylvania where lawmakers recently passed a state bill that will require insurance companies to begin covering autism treatments a year from now, next July. Private insurance companies doing business in the state will be required to cover diagnosis and traditional therapies considered by experts to improve communication, behavioral difficulties and learning deficits. Under the law, insurance companies would have a limit of $36,000 in benefits annually that they must provide for those who need it.

Insurance companies balked at this, saying that it would raise premiums. The PA lawmakers continued their work to pass the bill and now PA has a precendent-setting law on the books that could force insurance companies to cover needed treatments. Early-intervention can make a huge difference once diagnosed, and this law will ensure that those who need the care will get it.

California is known for the groundbreaking laws, so will we follow suit? One can only hope. In a state that allows Regional Centers to determine coverage on their own, with no state-wide mandate, there are many who are diagnosed and are falling through the cracks. Regional Centers will often delay decisions to run out the clock before a child starts school. Then, the treatments can become the school district's responsibility. In a system that is all about passing the buck, it would be good to see some accountability.

What could the average family do with $36,000 for treatments? Here is an example:

  • a year's worth of Occupational Therapy (52 weeks) @$100/visit $5200
  • a year's worth of psychological therapy (50 weeks) @$135/visit $6750
  • a year's worth of speech therapy (50 weeks) @$130/visit $6500
  • a year's worth of doctor visits (DAN) (10 visits) @ $400/visit $4000

That leaves $13,550 left over, for..incidentals.

What could you do with $36,000 per kid, annually until age 21?

Honestly, one of the hardest things about homeschooling is that we pay for all therapies privately. It puts a strain on our finances.

The point of insurance, is to provide care to the people who need it, and possibly turn a bit of a profit in the process. But the insurance companies have forgotten they are first and foremost an avenue for care. It is time to hold them accountable.

edited to add: Yes, in CA many are able to get coverage under other labels for certain treatments, for instance, DAN doctors, but it is a "don't ask..don't tell" type of arrangement. Some don't divulge that their child is diagnosed with autism, for fear at some point, their care will be denied as a "pre-existing condition" under HIIPA laws. If the insured doesn't carry continuous insurance, when next insurance is obtained, companies can deny services. This leaves many in fear and paying privately for services.

Are you listening, California lawmakers? 1 in 150 kids are diagnosed with autism. Two of them are mine. Now that Pennsylvania has done the right thing, when will California step up?

T, who just wants what is fair

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4 sent chocolate:

califmom said...

Because of the parity laws in California, most of our son's treatments have been covered by medical insurance (speech therapy, OT, psychotherapy, psychiatry), at least until he's 18. He never did qualify for Regional Center Services. Our hope is that the federal bill for parity will pass and extend that coverage to be lifelong.

Anonymous said...

very important post sis...i have worked with a lot of autistic kids through the school does seem to be on the rise...and early treatment can make a big difference. and btw...i tagged you!


The Glasers said...

To be honest, I do not think I would need to spend that much at present! I am pretty sure no SLPs in the state of South Carolina use the association method. It would be cool to get formal sensory integration with all of the fun stuff that goes with it. Plus, it would cover RDI.

momto4kidsny said...

I'm impressed that PA did something before California. It's great that alot of children in PA will be able to get the therapies they need! Now I just hope all the other states will follow PA like they do CA!
Early Intervention is the key to unlocking the world for our children.

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