Wednesday, May 13, 2009

Covering Autism Therapies: the ongoing process in Michigan

We've had a minor break though in Michigan regarding health insurance and covering the various expensive therapies for autism. Up until Monday, most health insurance companies in our state declined to pay for therapies such as Applied Behavioral Analysis (ABA) or Play Therapy.

Finally, according to this Detroit News article, Blue Cross Blue Shield is going to start paying for ABA for children between the ages of 2-5. This is great news for parents of young children as early intervention is found to be beneficial for most individuals. This is not so great news for everyone else who has children with autism older than the age of five.

As you will see if you click on the link above, the insurance company is under the threat of being sued. A seven-year-old autistic child's dad, Christopher Johns, filed suit in federal court in May 2008. According to the article he filed the law suit on behalf of "the more than 7,000 children" in Michigan who have autism.

One of the reasons insurance companies have declined to pay is because "long-term studies on autism educational therapies have been inconclusive and the treatments are experimental." Another reason is that although my state lawmakers are working on it, Michigan is not yet amongst the ten or eleven states in the U.S. where state law mandates coverage for therapies that parents seek out for their children with autism spectrum disorder.

I find it ironic that autism is classified as a health issue in the United States, yet it seems to be the school systems that help people the most. Unfortunately, even schools are limited in the amount of services they can provide due to budget restraints. Often, the special education division does not start the Individualized Educational Plan (IEP) process until a diagnosis is issued from a physician.

This is a concern because physicians, especially general family practitioners, are still learning how to spot the symptoms of ASD. Sometimes, as in the case with my child, autism isn't diagnosed until the age of six. This may mean a missed opportunity for early intervention, and, now, coverage from insurance companies.

So you see, it may be awhile before people with ASD in Michigan have access to the (often very expensive) services that may help them. There could be years of fighting before things start to improve. I will be watching the lawsuit while also monitoring the progress of state lawmakers in Michigan while they contemplate passing legislation that will be helpful to this cause. I'm not holding my breath just yet...


Cassavaugh Family said...

WOW thanks for the insight. I had no clue. It is good to be in the know. It will be interesting to see what comes of the lawsuit. I agree about physicians and their ability to recognize. We have been asking pediatricians in both IL and MI for almost 4 years now about things we thought weren't quite right. All I got was the "he's too young to label" or "you are just overly concerned". I'm so glad so much is happening to bring greater awareness.

mommy~dearest said...

I totally agree. It is the schools that help the most, and they're even limited. My son can't get OT because he doesn't have significant fine/gross motor issues. He DOES have some pretty intense sensory issues, but OT is not approved for anything but a consult for sensory diet in Michigan schools. Lovely.

*My word verification is "worse". OMG, too funny. Hopefully, it won't get any!*

LegoGuy64 said...

This site is intelligent and gives me the feeling that the folks here really care about the public.

In addition, I wanted to test to see if this site will honor my input.

Once I have that information, I'd like to be an active contributor and supporter of what you are doing.

Dr. Moore

Julie L. said...

To the Cassavaugh family: You are welcome for the insight.

To mommy-dearest: Oh, I hope nothing gets worse for you as I know everyone in your family has been sick! I've gotten some pretty funny verification words too, although nothing comes to mind at the moment.

It's unfortunate your son is not approved for more than a consult from OT.

Thanks Dr. Moore. Yes, I do care about the public and also value input. Your contributions will be appreciated here.

Morgan said...

No long-term data? Have they heard of Lovaas? Okay, now I'm on my soapbox.

I do want to point out an error. From what I know, the physician's diagnosis doesn't mean much in the schools. A child has to be diagnosed with autism by the school (the autism team here) in order for the diagnosis to be recognized. What gets me is that it takes so long! They started doing observations on this preschooler last year, and are still doing them! I could tell you in five minutes that he meets criteria. Okay, I'd better get some sleep and calm down.