Autism community has mixed reaction to insurance bill
by Jennifer Cohron
Apr 15, 2012 | 1715 views | 0 0 comments | 5 5 recommendations | email to a friend | print
The Alabama Senate passed a bill last week intended to expand the amount of insurance coverage available to families affected by autism.

Supporters of the Riley Ward Act said it would provide more access to therapies not currently covered by insurance despite being proven effective in helping children with autism.

“While this bill is not perfect, it is another step down the road to providing adequate insurance coverage to those on the autism spectrum,” said Sen. Cam Ward, sponsor of the Senate bill and father of the child that gave the act its name. “This bill will give employers the opportunity to offer insurance coverage for their employees that is unprecedented in Alabama today.”

However, the largest autism advocacy group in the United States withdrew its endorsement of the bill shortly before Tuesday’s vote because of a last-minute compromise that it said fell short on delivering meaningful benefits.

Lorri Unumb, vice president for state government affairs for Autism Speaks, said the substitute bill was “a solution in name only” that would provide little to no relief to families who pay thousands of dollars a year for autism treatments.

“The problem with this new proposal is that it doesn’t require coverage but requires only that insurers ‘offer’ the benefit, meaning the cost will not be spread over the entire insurance pool,” Unumb said in a press release. “Under the new proposal, which was crafted by the insurance industry, Alabama families are not guaranteed anything. After working hard with Alabama advocates to join 30 other states that have banned autism insurance discrimination, we regret that we must now withdraw our support.”

The bill as introduced would have required state-regulated insurance plans to cover the diagnosis and treatment of individuals with autism spectrum disorders.

Among the list of therapies included was applied behavior analysis, an evidence-based treatment that focuses on social skills such as looking, listening, reading and conversing — all of which are struggles for individuals with autism.

The new bill does not mandate coverage for ABA services but instead makes it an optional offering for medium to large-sized employers to purchase for their employees.

“We all think that ABA therapy is very important, but we accepted this bill without ABA therapy because of the improvements in other coverage,” said Bama Hager, policy advisor for the Autism Society of Alabama.

For example, Blue Cross Blue Shield agreed to increase its coverage for speech and occupational therapy to up to 100 combined sessions for children under 9.

Individuals with autism older than 9 are not affected by the bill.

A local mother, Pam Black, was not among those celebrating the passage of the Riley Ward Act last week.

Blue Cross Blue Shield stopped paying for therapy for her 13-year-old son, Ed, in 2010 because he is autistic.

Ed currently receives occupational and speech therapy through the local school system, but Black and her husband pay nearly $2,000 a year for Ed’s monthly psychological visits.

“It (psychological care) is absolutely necessary. ABA therapy for Ed would be about $50,000 a year. We don’t even explore that because we can’t afford it,” Black said.

Black said that while she is thankful for an ever-increasing public awareness of autism, most believe incorrectly that her family and others like them are receiving government benefits and that their autism-related medical expenses are covered.

When Black reads between the lines of the Riley Ward Act, she sees only empty promises.

“Children with autism did not deserve compromise; they deserve insurance coverage for their medical condition,” Black said.

The autism insurance reform bill must be voted on by the House of Representatives and signed by the governor before it becomes law. If passed, it will take effect in October.