Autism Coverage a Possibility

South Carolina will be one of the first states to institute state mandated autism coverage (starting June 1, 2008) thanks to a group of three moms who fought the system.

But why do insurance companies initially deny autism, sensory integration, and developmental delay coverage? Simply because it costs too much and according to them it is not repairable or curable.

Once upon a time Karianna at Silicon Valley Moms and Kari's Couch found out that insurance companies will NOT treat children with autism. However, states like South Carolina are now mandating insurance companies to do so.

With monthly treatments that can reach up to $5000 health care can become a burden and although my son does not have the autistic label...I know the health care burdens as well. Keywords such as sensory, oral motor, dyspraxia, apraxia, developmental delay send claims right back to us...Sorry, your responsibility.

"Once he was diagnosed and the insurance company learned that it was as the result of autism, they actually removed the coverage," Lisa Rollins, who has a five-year- old with autism, tells John Ydstie.

The insurance companies contended that autism was "strictly an educational issue and that it was not a medical problem," she says.

"Autism is diagnosed by a medical physician, it's not diagnosed by a principal," Rollins says. "It is also an organic brain dysfunction. It is not an educational issue…."

In September, Governor Edward G. Rendell urged Pennsylvania residents and voters to evaluate insurance for children with autism and the Autism Bulletin Blog has gone so far as to outline where services are covered.

There are 17 States that require some insurance coverage including California and Illinois (as part of mental health coverage). Currently, Illinois law requires insurers to cover autism-related services as they would a mental illness, according to a recent Connecticut legislative study.

My issue is that when it comes to occupational therapy, physical therapy, and speech therapy services are not covered because many of MY son's issues are actually labeled as sensory integration or developmental delay, not under autism (mostly because he does not have that label).

But, even if her were to have that specific label OT is needed because of sensory integration and therefore the insurance company can deny this, as they will not cover OT for sensory integration.

Nice loophole, eh?

Marcie writes more about autism at Discussing Autism.