When Jack was diagnosed with autism three years ago, our pediatrician prescribed speech and occupational therapy. She also prescribed applied behavior analysis (ABA) therapy. I walked out of her office fully anticipating wait lists and lots of appointments.
What I didn't anticipate was the blatant discrimination we were destined to receive at the hands of our insurance company. I didn't realize that an autism diagnosis equated a coverage death sentence for those needing treatment.
I had no idea I would hear one word over and over and over:
Denied.
Speech and OT were limited to a certain number of visits. (Seems as though one hour of speech therapy per month and two hours of occupational therapy per month were considered appropriate in the eyes of our insurers.)
Let me say that again. One hour of speech per month...for a nonverbal child.
If I hadn't lived it, I wouldn't believe it.
And as for the forty hours of ABA prescribed: Denied. Denied. Denied.
Hope. Denied.
We turned to our affluent Texas school district hoping they might help. We hired a lawyer. Drafted letters. Attended meetings. And got absolutely nowhere...
Hope. Denied.
Our child was sick. Our doctor prescribed evidence-based treatment. And it was completely up to us to pay for it.
I wish I could say our story was the exception as opposed to the rule. The sad reality is that in the vast majority of homes affected by ASD across our country, children are not receiving services. There are some savvy corporations that have stepped up and done the right thing by covering treatments. (Microsoft and Home Depot cover ABA.) There are also several states that have mandated coverage. (Texas, Louisiana, Arizona, Florida and Pennsylvania to name a few.)
Unfortunately, these band-aids aren't controlling the blood loss. The wound is gaping. Major surgery is warranted.
But today, maybe, just maybe, we have some reason to hope...
Per the Autism Votes web site:
(November 5, 2008) President-Elect Barack Obama's win last night may prove to be a win for the autism community as well. In his campaign statement on Autism Spectrum Disorders, Obama has committed to bringing autism insurance reform to our entire nation.
His statement reads, Obama and Biden "will mandate insurance coverage of autism treatment and will also continue to work with parents, physicians, providers, researchers, and schools to create opportunities and effective solutions for people with ASD."
You can read a draft of President Obama's federal mandate for autism insurance coverage HERE.
Here's to coverage for treatment, no matter what your zip code or your bank balance is. Here's to acknowledging the fact that autism is treatable and insurance should cover that treatment. Here's to doing the right thing.
Here's to hope.
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To join me on this journey of hope, please register for legislative updates at Autism Votes.
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9 comments:
very nice blog, i wish you the best
Even thought William was just diagnosised in July With ASD. I've been around and around with the insurance companys. As a matter of fact.. I've been on the phone this AM calling trying to get claims paid. Lets pray the our new President can shead some light on the subject and get this fixed.
Amen to that!
I didn't vote for him, but if he gets BCBS to pay one CENT, I'll wish I had! (I live in Texas and so far the legislation has meant nothing, at least to us.).
Thanks so much for your continued work in this area.
Jill (mom to Andrew -ASD, and Henry)
Yes, here's to hope. We had to get new insurance and when I applied, they agreed to cover us - oh, except for our youngest son. No health coverage at all!
BTW, on a lighter note, you've been tagged. Sorry! See my blog for the rules: http://spectrumkids.blogspot.com
I don't mind being tagged at all China! All though I'm the world's worst at actually following through. Will do my best!
I hear you about the insurance. We were completely denied coverage for even ST, OT for years. Now, only after our state leg just passed a law mandating some coverage(thanks to Autism Votes for their help in FL), now our company will pay for 2 OT sessions a month. The law is not ideal, there are problems with it, but it's a start. We're thrilled to even have that small bone!
When our son was first dx'd his neuro recommended ST, OT, and ABA 5 times a week. We got coverage through the state programs until he turned 3 but after that we've paid the bucks. It was of course worth every penny.
But I hope Obama can make it easier for parents coming up behind us. So they can focus on helping their children rather than taking out a second mortgage to pay for therapy.
Katherine
I live in AZ where it was passed and should take effect June 2009. However, our insurance carrier is from Minnesota. ;o( I'm looking forward to someone finally stepping to the plate on a federal level. GREAT POST!
Mommy of two ASD kids in AZ.
I came upon your blog from a friend's blog.
I applaud you for keeping up with all the information & laws associated with autism. As a teacher who has had many children with autism in my classroom ... it's always refreshing to see a parent that will fight for their child & come prepared with all the past history!
Good luck with everything ... I'll be hoping for you, too!
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