Monday, September 15, 2008
Friday, September 5, 2008
On July 1, the father of a 7-year-old with autism filed a lawsuit
against Blue Cross Blue Shield of Michigan to force the insurer to reimburse
about $8,000 paid for therapy, according to one of the family's attorneys, John
J. Conway of Detroit. Another suit over autism therapy coverage was filed in
April against WellPoint, Inc. subsidiary Anthem Blue Cross and Kaiser Permanente
Autism is a baffling and costly developmental disability that
affects about 1.5 million Americans, according to the Autism Society of America
(ASA). The disorder is marked by impaired social interaction and communication,
and engagement in repetitive behaviors. The condition is on a continuum of
"autism spectrum disorders" that includes Asperger syndrome. Autism has become a
hot-button issue as its prevalence has increased dramatically in recent years
and as some critics have linked childhood vaccines to the condition. According
to the federal Centers for Disease Control and Prevention (CDC) in Atlanta, the
incidence of autism has almost doubled since 2000, now affecting about 1 in 150
American children. Autism cases in Michigan have skyrocketed from 4,700 in 2002 to 11,000 in 2006, according to CDC.
Treatment of autism can be expensive.
The ASA estimates that the lifetime cost of caring for a child with autism ranges from $3 to $5 million.
During a hearing scheduled for Oct. 22 in the
U.S. District Court for the Eastern Division of Michigan, Southern Division, the
court will consider a motion to certify the Michigan Blues suit for class-action
status. Certification as a class would broaden the suit "to represent other
potential claimants in the same situation" as his client, explains Conway.
At issue in the lawsuits against the Blues plans is an intensive one-on-one therapy
called applied behavioral analysis (ABA). A full course of ABA therapy costs
upwards of $90,000, according to Conway.Conway says the Michigan Blues plan
sent hisclient's family "a pretty bare-bones, perfunctory denial that says, 'Our
in-house people think [ABA] is experimental.'"Michigan Blues spokesperson
Helen Stojic declines to comment on the specifics of the lawsuit filed against
the plan. But, she says, "Blue Cross Blue Shield of Michigan understands the
concern and is very sympathetic to the challenges of families dealing with
autism. However, the push to expand employer insurance coverage — through the
courts or legislation — comes at a time when many employers are seriously
struggling to pay for their existing coverage."
Conway says that ABA is endorsed by the American Academy of Pediatrics, the U.S. Surgeon General, the Association for the Science of Autism Treatment and the New York State Department of Health, among other authorities, and notes that ABA therapy is covered by Blue Cross and Blue Shield of Minnesota.
"Applied behavioral analysis isn't experimental to Blue Cross and Blue Shield of Minnesota," he says. "They pay for the treatment in Minnesota, so we don't know why kids covered in Michigan don't get it, even though they're both covered by Blue Cross entities — same therapy, same medical cases."
Its interesting to me that as a nation we can relate poor education to higher crime rates yet we seem incapable of treating a disabilty that effects over 1.5M American children which if untreated will result in the need for lifetime care at an average cost of $3M-$5M. An autistic childs mind works differently an in integrating them into society as a whole we may find a whole host of creative thinkers and productive adults if we act. How can we not act in good conscience on this subject?