Some of the biggest health insurance companies in California have agreed to cover the cost of behavioral therapy for children who have autism spectrum disorders. This news comes after pressure was applied on the insurers by regulators. This could help some parents in California to afford the therapy their children need. However, there seems to be some loopholes.
One of the most commonly prescribed forms of autism therapy is called applied behavioral analysis. In short, what this therapy does is train children who have autism to do some basic things that children who do not have autism would automatically start doing over the course of typical child development.
Most of these things could be described as “social skills”. It could involve the child learning how, (and when), to make eye contact with other people, (for example). There are a lot of necessary skills that can be taught through this form of therapy. Children can be prescribed up to 40 hours of week of behavioral therapy, which can cost $70,000 a year, or more, per child (in some cases).
There is a California law that requires health insurance companies to provide customers with the same level of benefits for mental disorders as they would for physical ailments. The mental disorders category would include autism. Currently, there is a bill being considered by the California state legislature that would specifically name applied behavior analysis as a covered therapy. This bill has not yet been passed into law.
Previously, some health insurance companies in California have resisted covering the therapy that autistic children need. The insurers had concerns about the rising demand for these very expensive services, and they argued that applied behavior analysis is not a medical treatment. Never forget that insurance companies are interested in making a profit for themselves.
After some pressure by state regulators, two insurance companies, Anthem Blue Cross, and Blue Shield of California have agreed to cover the initial cost of the applied behavior analysis treatment. Each company will cover a minimum of six months of treatment for HMO patients. They will only do this, however, if the treatment has been deemed “medically necessary” by healthcare providers.
This is where the potential loopholes become apparent. There isn’t anything specifically stating that these insurers will continue to cover the treatment after the first six months of it have passed. Each insurer has decided not to cover the treatment unless it can be offered under the supervision of licensed professionals. There is currently a shortage of licensed professionals in California who can provide this therapy.
Hopefully, the loopholes will be closed if the bill becomes a law. If that happens, then California will join Virginia in the list of states that require insurers to cover treatment for autism.
Image by Becky Wetherington on Flickr