Monday, June 22, 2009

Update: Blue Cross Ordered to Pay for ABA in Michigan

Author's Note: This is an update of a post I wrote back in May.

Thank goodness for Facebook and Talk Autism (Facebook), a group I get updates from on my home page. Having just arrived home from vacation after a week of no internet access, I would have taken longer to find this link, which is an update containing good news about the lawsuit against Blue Cross/Blue Shield. The only criticism I have with this article is that the reporter called autism a disease. I prefer to use the word condition because a negative message is attached to the d-word.

Otherwise, the reporter did a good job reporting that the insurance provider, Blue Cross/Blue Shield (BCBS), has been ordered to pay for Applied Behavioral Analysis, a treatment that many families with autistic individuals pursue. In the article, the reporter defines the therapy, summarizes why BCBS hasn't paid in the past and explains the difference between the lawsuit and the legislation that is going through Michigan's state legislature. This article goes into a little more detail than the ones I usually find in The Detroit News. However, the latter article does offer up quotes from Gerard Mantese, the attorney for Christopher John's, the father who pursued the lawsuit back in May 2008 through the U.S. District Court.

Here are the last two paragraphs from the first article mentioned as found on Consumeraffairs.com:

"As with many developmental and psychological disorders, autism isn't covered by most medical insurance plans. Depending on the severity of a child's autism — which varies greatly from case to case — intensive speech and developmental therapy can cost nearly $100,000 per year. In Michigan, where the instant suit was filed, the state House has introduced two bills mandating coverage for diagnosis and treatment of autism-spectrum disorders, including Asperger Syndrome and Rett Syndrome. HB 4776 applies specifically to plans issued by Blue Cross; HB 4183 applies to all other insurance companies.

"In the settlement, Blue Cross agreed to reimburse the families of more than 100 autistic children who paid for their own behavioral therapy over the past six years. Included in the settlement are families covered by a Blue Cross policy who never actually submitted a claim."

Looking into the future: I'm guessing that most of the families who pursue ABA live in urban areas like Detroit, Grand Rapids and Lansing. Those of us who live in rural areas have a difficult time finding a local provider of the therapy. Perhaps, if more people can pay (using insurance) than more providers will pop up in less populated areas of the state. One can only hope.

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