View this article online: https://www.claimsjournal.com/news/midwest/2007/11/12/84960.htm
Fully insured health plans would be required to cover diagnosis as well as treatment for autism under an Ohio House bill advocates say would expose autistic children to early treatment that will benefit them the rest of their lives.
The proposal, which has bipartisan sponsors, is modeled after the two-month-old mental health parity law that requires health insurance providers to cover certain psychological conditions. Currently, many health plans cover the diagnosis of autism but not treatment.
“I just feel like taxpayers shouldn’t have to pick up the tab,” said Tamara Heydt, a mother of two autistic children, 9-year-old Gavin and 11-year-old Garrett. “My insurance should have to pay for it. Insurance companies pay for other neurological disorders. I feel like it’s discrimination.”
The family spent $60,000 on treatment in one 18-month period.
The Heydts were able to stave off bankruptcy because her children qualified for Medicaid waivers after their diagnosis. The family is insured through Medical Mutual of Ohio.
Joseph Gibbons, director of government relations for Medical Mutual, said his company doesn’t cover autism treatment and doesn’t believe any employer who buys insurance has ever asked for the coverage.
Insurance industry officials want more details about the House bill, which is being sponsored by Republican Rep. Jon M. Peterson and democratic Rep. Ted Celeste, both of suburban Columbus. Insurance officials are concerned the bill would lead to more mandates based on a disease or health condition.
“Each individual has the belief that their cause is the one that the government needs to find the solution to,” said Kelly McGivern, president of the Ohio Association of Health Plans. “We believe employers who buy policies should make the decision.”
Continuing treatments, involving such things as speech therapy, a psychologist working on socialization skills and home health aides, aren’t covered, said Jacquie Wynn, director of the Center for Autism Spectrum Disorders at Nationwide Children’s Hospital. Autistic children, she said, need 30 hours to 40 hours of intervention a week.
Wynn said 30 percent of families who come to the center for treatment leave because they can’t afford it.
“There’s a cost savings in the reduction of aggressive behavior or the self-care skills they learn,” she said. “With short-term, early intervention in their early years, you see the payoff in their lifetime.”