Tuesday, October 30, 2007

Story Idea-insurance

This person wants more coverage on insurance issues. This item was emailed to this blog--AR

Hi-I wanted to contact you concerning your coverage of autism. I do not live in your area but since you, as a member of the press have asked for input I am taking this oportunity to express my opinion concerning the presses typical coverage of autistic disorders.

I am the Father of a 4 year old by who was diagnosed with an Autistic Spectrum disorder at 18 months. To our knowledge our son has never recieved thimerisol in any of his vaccines. In fact, on the day he went for his 18 month check up he was diagnosed. This check up included giving him the MMR vaccine. To be clear-he was diagnosed as literally minutes before recieving the vaccine.

I do not discount the posibility that mercury or vaccines play a role in some childrens autism. However i find it to less likely than the billions of other potentialy viable causes. I say this because it has been tested and tested and tested and the tests do not indicate this is the cause. Meanwhile just about everything else has not been tested.

You, as a member of the press are looking for controversy. I understand that. Unfortunately you, and the rest of the press are missing the real controversy which is the blatant discrimination by the medical insurance industry. Over 90% of health insurance policies will not cover what main stream medicine recommends to treat children with these disorders. Occupational, Speech and behavioral therapies.

There is no controversy among health professionals that these interventions, when administered early, result in the best outcome for our children. Yet this contoversy is drowned out by the dead horse argument of vaccines and thimerisol. Moreover the paltry sums of funding going to finding treatments for autism are being drained to fund even more testing for an argument that has already been decided. The press has an obligation to report on controveries that affect public policy.

Where is the report that asks the insurance industry-Why are you descriminating against Autistic Children? If you investigated this, you will find that the justifications for this has no merit. We live in a society in which treatment or erectile dysfunction are funded by insurance yet treatments for autism are not-why? The most blatant effect of this descrimination is the economic reality that without insurance unding for autism treatments, no economic incentive exists for finding better treatments. Who is going to fund research into something they will not be paid for? Examples of the lack of economic incentive and/ or misguided priorities for research in finding better treatments are numerous.

I will give you one: Medical science has known for over forty years that abnormal EEG's, siezures and autism are closely related. However, to date, no research has ever been conducted to determine whether autistic children- who are given drugs to correct abnormal EEG's and eliminate the potential for siezures-autistic symptoms get better or worse after treatment with these drugs. The why is obvious-drug companies will be paid for treating siezures, they will not be for treating Autism.

My wife and I funded out of our pocket over $30,000 last year for main stream medicine recomended therapies. Afer considerable effort our insurance company reimbursed $408. Because my insurance was under Cobra law; due to my changing jobs I paid for our health insurance. The premiums were $1200 per month or $14,400. I currently make $84,000 per year plus benefits. Congress is currently trying pas legislation to give free insurance to children whose families make up to $64,000 per year.

Yet this coverage will not cover Autism nor will the coverage the rest of us pay for through our employer sponsored plans. A few states are passing legislation to change this problem. However, neither the federal government under which ERISA sponsored plans (the laws which govern insurance plans for most of us) or my state has passed such legislation.

I do not know what your state is doing. But I urge you to find out. We are overwhelmed with the 24/7 job of caring for a child with an ASD. It is outrageous to me to have to pay insurance pemiums and taxes whch fund every disorder except the one my son has.

Richard Fauth, P.E., M.B.A, CSSB.


Cathy said...

Amen Richard.
There is ONE bona fide, proven via study after study treatment for autism. ABA therapy. It is not "alternative" - it is the only accepted treatment. Some kids have been 'recovered' using only intensive ABA therapy. Why is there no insurance coverage for ABA? Schools pick it up at age three - but is that too late? Has the window closed? And not every school can provide it. ABA is an intensive, one-on-one therapy that needs to be intensive (20+ hours a week). That is a little expensive and would hurt the insurance companies pockets.

Anonymous said...

Actually, there is very little empirical support for ABA. It's far from proven.

Richard, what kind of treatments cost you $30,000? Are you talking about bil-med treatments, or behavioral therapies?

Anonymous said...

I understand your frustration. My son was diagnosed early. I've heard a million times over to "get an early diagnosis for the best prognosis". But where will the money come from to pay for the therapies? All the coverage that autism is getting, yet I've not heard a word about the outrageous cost of treatment. An early diagnosis doesn't mean anything if you cannot afford it. And sadly many cannot afford it.

A very minimal 4 hours of ABA per week (which worked wonders for our son till we ran out of money) runs $16,000 - $18,000 per year. Out of pocket.

For me, the expense of treating autism makes me sad every day. Because having enough money to pay for effective therapy could mean all the difference in my son's future; living a very difficult life or living a good life.