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Should Insurance Cover Autism Treatments?

Critics Argue Autism Mandate Would Raise Costs For All

POSTED: 4:04 pm EST February 27, 2009
UPDATED: 8:12 pm EST February 27, 2009

A growing number of children across the United States are struggling with autism. In Massachusetts, 10,000 school aged children have the disorder.

Many of their parents are engaged in a battle of their own, trying to get support for the critical treatment their kids need.

“They bring us so much joy. But I also want people to understand the struggle,” said Maura Buckley, mother of two autistic sons.

In the Buckley’s house, every day is centered around getting their boys the help they need.

“Both are non verbal,” Buckley said.

Seven-year-old Neil, and his younger brother, Tyler, were diagnosed with autism when they were toddlers. Since then their parents have constantly been fighting insurers to pay for intensive therapies their parents argue the boys need.

“The behavioral intervention piece has never been covered. Without it they tend to regress, they tend to lose skills,” Buckley said. “We spend from $1,000 probably up to $5,000 a month on private therapies for them.”

Until now, most health insurance companies classify autism treatment as behavioral in nature, not medically necessary.

State representative Barbara L'Italien, whose 18-year-old son is autistic, said, “It's a neurological disorder and it's never been covered under medical insurance and we aim to change that. I've fought the battle and paid the out of pocket price trying to make sure my son had the best possible outcome.”

L’Italien helped draft a bill that would require health insurers in Massachusetts to provide coverage for the diagnosis and treatment of autism; services like pharmacy, psychiatric and rehabilitative, which includes behavioral and speech therapies.

“Those who are unable to pay out of pocket just go without. And those who are able to do the best they can and it shouldn't be a system like that,” she said.

“We’ve remortgaged our home,” said Buckley. “We've begged, borrowed and drained our retirement accounts and maxed our credit cards. We need legislation that will help up pay for these services.”

A spokesperson for America’s Health Insurance Plans, an industry group that represents insurance companies, told NewsCenter 5 that too many mandates raise costs for everyone, though they were unable to provide specific cost estimates, because the scope of the proposed mandate aren’t yet known.

Proponents admit covering autism services would add about one percent to health care premiums, or about $50 more per year.

The insurance industry spokesperson also noted that many of these services for autistic children have historically been provided by school departments, but with budgets falling victim to the financial crisis, schools may be making cuts.

So far, eight states have passed similar legislation. Twenty-six other states, including Massachusetts, are trying to do the same.

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