Health Team

Advocates seek insurance coverage for autism treatment

Posted June 27, 2013

Autism diagnoses soar; NC has high rate

— Advocates for people with autism want access to critical treatments, but legislation that would allow it is hung up in the General Assembly.

Most insurance providers cover speech, occupational and physical therapy, but North Carolina is one of 17 states where insurance doesn't cover applied behavior analysis, also known as ABA therapy.

The state House voted overwhelmingly last month to approve legislation that would require insurers to cover ABA therapy, but it has languished in a Senate committee since then.

Scott Taylor said he and his wife paid $1,500 out of pocket for ABA therapy for their 11-year-old son, Daniel. He credits the strides his son has made to the therapy, which involves a team of therapists reinforcing positive behaviors and trying to eliminate negative ones.

"It makes a big difference," Taylor said. "It is time intensive, one on one, and so it's not cheap."

A year ago, he said, they had to halt the therapy because they could no longer afford it.

"These children cannot wait on the treatment that they need and that their doctors are prescribing," said Lorri Unumb, vice president for government affairs for advocacy group Autism Speaks. "To have an insurance policy that purports to cover autism but doesn't cover the single most important treatment for autism is not meaningful."

Families battle insurers over proposal to cover autism thepay Families battle insurers over proposal to cover autism therapy

Insurance companies say ABA therapy is an educational treatment, not a medical one, and they don't cover educational therapy. It also would raise premiums for other policyholders, according to insurers.

"The cost is chump change to what it would cost to care for folks like Daniel when they become adults," Taylor said.

The North Carolina Chamber also opposes the bill, calling the insurance requirement a burden for businesses.

Sen. Tom Apodaca, R-Henderson, said the Senate has no plans to take up the bill.

"Until we get guidance under the Affordable Care Act, we're kind of tied," Apodaca said. "We hate doing it because we all love this bill and feel like it's needed."

Guidance about mandates under the national health care reform law is expected early next year, he said.

Unumb said she doesn't see the federal law as an impediment, saying advocates are working to amend the bill to remove health exchanges and small businesses from the ABA therapy coverage requirement. The changes would bring the proposal into compliance with the Affordable Care Act, she said.

One in every 88 children is diagnosed with autism, according to the latest estimate by the Centers for Disease Control and Prevention, and Taylor said ABA therapy would help children like his son live normal lives.

"We all want our child to grow up to live as independent and fulfilling a life as possible, and that's what I want for Daniel," he said. "This therapy is going to help him do that."


This story is closed for comments.

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  • BaseBallMommy Jul 2, 2013

    How sad is it that insurance won't cover that but if your child is on medicaid they get everything for free. A little messed up I think!

  • qrbyrd Jul 1, 2013

    If your insurance pays for speech therapy and occupational therapy be glad. My child is autistic and our insurance UnitedHealthcare will not pay for anything. We do what we can at home but it's just not the same.

  • readme Jul 1, 2013

    It would be much cheaper to pay to have someone train the parents to do a lot of this themselves. We have to use some common sense here. This is ongoing care that could last for years, and there's absolutely no guarantee any of it will work. It's a sad situation, but we really are just a the tip of the iceburg for knowing how to manage autism. People who blindly say insurance companies should cover this 100% no qustions asked are not seeing the big picture.

  • LuvLivingInCary Jun 28, 2013

    no they won't pay for aba but all the dr.'s gotta do is write a prescription and regardless of the cost the drug will be paid for.

    typical answer to society. give them a pill.

  • thewayitis Jun 28, 2013

    These kinds of treatment are very expensive, and there is only so much money to go around. I know some parents of kids with autism who worked with the experts to learn how to do the treatments at home themselves. This provides a huge cost savings all around. We need more options like this that keep costs down.

  • jobs5 Jun 28, 2013

    The cost for families of children with Autism to afford ABA therapy services is beyond the means of most families. Insurance companies should step up and cover these services. The rate of Autism diagnosis in this country is too great for these huge companies to turn a cold shoulder on providing these treatments.

    J. Drewes
    Achieve Beyond Pediatric Therapy and Autism Services

  • fishbowl Jun 27, 2013

    I love how Sen. Tom Apodaca, R-Henderson states that it would be a burden for businesses. Tell me sir, what type of burden do you think it is for these families? If you have insurance then should you not be able to receive the treatment necessary for treatment? Since autism takes a multi-disciplinary approach it would be expected to include behavior. If a patient had a heart attack, it would be expected for emergency care, the post care, and cardiac rehab. This requires multiple disciplines. It is ignorant to believe that these children can be treated from one dimension. Plus, everyone knows this is over money NOT whether it is needed or not.

  • dracarys7 Jun 27, 2013

    ABA = therapy, NOT education. Insurance companies should not get to pick and choose WHAT kind of therapy they will cover. All or nothing, in my opinion.

  • mceldridge08 Jun 27, 2013

    There's no way the schools can provide the kind of treatment some of these kids need, nor should they have to. These families are paying the premiums for health insurance, and they should get what they pay for. I, for one, would gladly pay a little bit more for my health insurance so that kids with autism can get the treatment they need. After all, that's what insurance is for, right--spreading the risk?