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Autism Insurance Legislation May Help Local Families

Insurance representatives say it could force a rise in premiums.

Legislation passed in Albany late last month to require health insurance in New York state to cover the costs of screening, diagnosis and treatment of autism and autism spectrum disorders.

The bill, if signed by by Gov. Paterson, would make New York the 22nd state to make autism coverage required by insurance companies. 

"In the past, it was arbitrary if insurance companies covered it," said Assemblyman Robert Castelli (R, C, I-Golden's Bridge), who co-sponsored the bill. "This law requires insurance companies to provide coverage."

Autism spectrum disorder is a neurological illness that impairs the brain's ability to develop normal cognitive, social and communication skills.

The pending Autism Insurance Bill will extend the benefits to those living with autism throughout their lives; previously, treatment coverage ended once an individual turned 18. 

With increased services, insurance premiums may go up, said Leslie Moran, a spokesperson for the New York Health Plan Association, an insurance industry group. The bill's sponsors acknowledged in their press release it may be as much as 2 percent, she added.

"We do have early intervention programs in place—which may not be to the extent some families would like, but in a time when we're trying to figure out how to provide access to insurance to more people, it's tough to argue for providing more coverage to some."

But costs for diagnoses and treatments outside of what schools can provide are staggering. Advocates say the focus should be helping children and adults reach their full potential.

"The earlier the better," said Gary Silverstein, Executive Director of the Therapy Center in Bedford Hills, who said children with disorders on the autism spectrum have a better chance of success when diagnosed as early as age 1 or 2. "Group and family therapy is tremendously helpful for adults—and not typically covered by insurance."

Lorey Leddy, who has a 9-year-old son with autism in the Katonah-Lewisboro schools, said she feels extremely fortunate to be in a school system with comprehensive services like speech, occupational, and behavioral therapy, but the districts are limited in what they can do for academic performance and educational achievement.

"The district just doesn't have the resources to provide the extensive social skills and behavior therapy that many autistic children need as they grow older," said Leddy. And before her son even entered the school system, they incurred steep diagnostic costs: $3,500 on a comprehensive evaluation to present to the school district.

Such expenses would be covered under the bill.

As her son grows toward adolesence, Leddy has sent him to private therapy at a cost of $1,400 per 14-week session, which supplements school therapies, to help with new social pressures he's experiencing.

"It can be tens of thousands of dollars in out-of-pocket expenses," she said. Not every family can do it, and not every family has the benefit of the K-L district's services, she added. "With school districts cutting back on special education services this new insurance coverage will be critical."

Castelli said he was hopeful about the legislation being signed into law.

"It could not come at a more urgent time. The Centers for Disease Control and Prevention now estimates that the number of children with autism is approximately one in 110 nationwide, up from 2006 estimates that had the figure at about one in 150 children," he said.

m&m's mom July 17, 2010 at 02:16 PM
It's a dangerous bill that few understand. It will potentially mean the loss of speech & OT coverage, leaving many without services. My son has autism & receives these. If passed, it'll take the burden off the schools but may not be covered. Your child will have to go in front of a committee to be approved for services. Doctors may have little say in decisions. Please read below for yourself. Insurance Lobbyists Have Succeeded in Getting an Autism Insurance Bill Through the NYS Senate, the Assembly Version, A10372A. Do you realize that this bill takes the decision for treatment options related to autism OUT of the hands of doctors, dentists, licensed OTs, PTs & licensed speech therapists & places the decision in the hands of 4 NYS agencies? IT DOES! A10372A states: (B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTENDENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH & THE COMMISSIONER OF THE OFFICE OF MENTAL RETARDATION & DEVELOPMENTAL DISABILITIES SHALL, NO LATER THAN 12 MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARAGRAPH, PROMULGATE & THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH SHALL IDENTIFY TREATMENT & THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT & THERAPY OPTIONS SHALL BE EVIDENCE-BASED, PEER-REVIEWED & CLINICALLY PROVEN. To read the full bill, go to: http://capwiz.com/nsasa/utr/1/OKPTMRZZBY/NVZIMRZZFP/5346618091

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