Mythbusting: Insurance Coverage for Autism Treatment

Dr. Lori Warner, Dr. Ruth Anan of Beaumont's HOPE Center, and Lynn Weimeister from Beaumont's Legislative Affairs department presented Lieutenant Governor Brian Calley with a handmade painting created by children in Beaumont's autism treatment programs.

It’s still Autism Awareness month, and it has been a whirlwind! On March 30th, the Michigan legislature passed a set of bills that will require insurance companies to cover evidence-based treatments for children with autism spectrum disorders. We were thrilled to be invited to attend the official bill-signing ceremony last Wednesday when Lieutenant Governor Brian Calley signed the bills into law. There have been so many families and legislators who worked tirelessly over many years to get where we are today. Michigan is now the 30th state to pass autism reform legislation!

These bills passed, and they passed by a strong majority. This was amazing because there was plenty of opposition to the bills. Please understand that this opposition was NOT because other people do not care about children with autism! It was more from the perspective of those who do not want government mandates at all, or worried that the bills would be too costly, or from the perspective of those who worried that autism was receiving “special treatment” and that children with mental illnesses were not included in the bills.

Myth #1: Paying for treatments for children with autism will cost too much.

From a financial framework, we were able to show that when we do not intervene appropriately for children with autism, costs can become staggering. It is estimated that the lifetime costs for an individual with autism are $3.2 million, which in Michigan translates to about $58 billion! However, early and intensive intervention can reduce the costs to taxpayers (including funds needed for special education) and families. When children receive appropriate treatment, they are less likely to need as much support in schools and later in life. Rather, they can become independent and contribute to society with dignity. So helping children NOW, though it does cost money, actually saves money in the long run. This is really a win-win situation.

Myth #2: Children with autism are receiving “special treatment” compared to children with mental illnesses, and that isn’t fair.

First of all, please understand that we who help children with autism do support mental health parity! Many of us also work with children who suffer from other disorders. Mental health parity means that insurance companies would cover interventions for mental health conditions to the same extent that they cover interventions for physical health conditions. This is important, and we join in the fight for this cause. For many families, even though they have some insurance coverage for treatment, they still struggle to afford their co-pays and deductibles. For others, they cannot afford this at all and their children may not get the help they need.

It is important to note, however, that autism is not a “mental illness”. It is a neurodevelopmental disorder that also often has many associated medical issues such as gastrointestinal problems, seizure disorders, etc. There are no medications to “treat autism” and the type of therapy needed is often very different from what we would do if we were working with a child who was diagnosed with anxiety or depression, for example.

Secondly, autism was given a very bad form of “special treatment” – it was completely excluded from most insurance coverage, unlike other diagnoses. So rather than having inadequate coverage for treatment, there was no coverage at all.

Myth #3: The autism legislation means all companies will pay 100% for all autism treatments beginning now!

The legislation was a very important first step, and now insurers and practitioners must work to set up the structure to deliver these services. Families need to educate themselves about what the legislature means to them.

The bills were signed on April 18, 2012 and will be fully enacted in 180 days. This means that in mid-October, coverage plans will be offered to employees. For most plans, the actual coverage does not begin until the next calendar year, which is important to clarify.

“Coverage” means that now certain therapies and evaluations will be covered in the same way that other services are covered, meaning there will be approved providers, co-pays, and deductibles. These will vary from plan to plan.

Some companies are not covered by the mandates; and Senate Bill 981 was introduced to address the “self-funded” companies who can choose what coverage they will adopt. This bill set up a fund to reimburse expenses. The process is far from finished – we providers are meeting often to determine the best way to increase the number of providers available in Michigan. Many highly-trained therapists have had to leave the state due to lack of jobs in Michigan – this is changing! But it will take time to build up the services to help all of the 15,400 children in Michigan who have been diagnosed with autism!

For more information on what the bills mean to your family or to families of those you know and love who are affected by autism, Like Us on Facebook page and Subscribe to this blog. We are working hard to keep bring you all the latest information!

—Lori J. Warner, Ph.D., LP, BCBA-D, Director, HOPE Center at Beaumont Children’s Hospital

1 Response to “Mythbusting: Insurance Coverage for Autism Treatment”

  1. 1 Anonymous April 26, 2012 at 10:00 am

    Kudos to Dr. Warner and Dr. Anan! Thank you for being our champions for all children diagnosed with autism. You are two of my favorite heroes! We are so fortunate to have you as part of our team at Beaumont. Keep up the amazing work! Deanna

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