Insurance Industry Speaks Out Against Our Efforts!

[Guest guest]

Insurance industry opposes autism funding proposal

The Business Journal of Milwaukee

by Ben Fischer

Gov. Jim Doyle's proposal to require insurance companies to cover at-

home treatments for autism is drawing skepticism from health

insurance companies.

While details of Doyle's proposal were expected to be released March

16, the health insurance industry is already gearing up to oppose it,

if only out of a philosophical objection to mandated coverage of any

condition. The autism mandate is no different, said Phil Dougherty,

lobbyist for the Wisconsin Association of Health Plans, Madison.

" It's still an additional cost, and you're adding costs on top of an

already unaffordable, or nearly unaffordable, program for a lot of

small employers, " Dougherty said. " As you add costs, you're

preventing someone else from affording coverage. "

Autism, a neurological disorder that impedes social interaction and

creative thought, has been a political issue throughout Doyle's time

as governor.

In 2003, Doyle's administration said it would end Medicaid funding

for autism treatment on the heels of a similar federal decision, but

then was able to secure permission from the federal government to

continue state-supported autism treatment.

Then in 2005, Doyle's proposed budget removed funding for the

program, only to later agree to have $26.7 million put back in the

budget under political pressure.

Seventeen states mandate some kind of autism coverage, according to

the National Association of Insurance Commissioners, Washington, D.C.

Now in Doyle's third budget preparations, he has promised full

funding for state-sponsored coverage. But he will also demand that

private insurance pay for those who don't qualify for a Medicaid

waiver or are put on a waiting list.

That's necessary because autism diagnoses in children attending

Wisconsin public schools have increased from 400 in 1992 to 5,000 in

2005, said Nissan Bar-Lev, Wisconsin's special education coordinator

for the northeastern region and member of the Governor's Council on

Autism.

" Since the state has already invested probably more money than most

into autism, (Doyle) is thinking, 'who else can help out?' and

there's the private sector, " said Bar-Lev.

[Guest guest]

Veeeeeeeeeeeery interesting!! Just like in South Carolina, they're

not using the " experimental " argument anymore--this is a variation

of " because it's too expensive. " An INCREDIBLY weak argument. You

guys in Wisconsin can win on this!!! What you need to say is that if

we're now rationing healthcare, let's put everything on the table

first and then choose. There are many, many very expensive items

that these insurance companies are paying for which are far less

efficacious than autism treatments.

Just yesterday, here in NJ I called our new medical insurance company

and was told that they would not cover ABA, speech or OT services for

autism, the reason being that they are considered " experimental and

investigational " . However, and you are going to LOVE this, my son

can get an unlimited number of visits each year with a " therapist "

who is either a masters degree level social worker, psychologist or

psychiatrist (the treatment modality is " at the discretion of the

therapist " but CANNOT be ABA, OT or speech). The rest of the family

can have unlimited visits as well after a $750 deductible! Just for

grins, I called one of the psychiatrists in the network and found out

she charges north of $200/hour. And it's all covered!! So my

insurance company won't pay for a thing that is EVIDENCE BASED, but

will pay all day long for my lovely little son to tell a shrink I

don't know what...maybe what a bad mommy I've been all these years!!

Unbelievable.

Jenna

>

> Insurance industry opposes autism funding proposal

>

> The Business Journal of Milwaukee

> by Ben Fischer

>

> Gov. Jim Doyle's proposal to require insurance companies to cover

at-

> home treatments for autism is drawing skepticism from health

> insurance companies.

>

> While details of Doyle's proposal were expected to be released

March

> 16, the health insurance industry is already gearing up to oppose

it,

> if only out of a philosophical objection to mandated coverage of

any

> condition. The autism mandate is no different, said Phil Dougherty,

> lobbyist for the Wisconsin Association of Health Plans, Madison.

>

> " It's still an additional cost, and you're adding costs on top of

an

> already unaffordable, or nearly unaffordable, program for a lot of

> small employers, " Dougherty said. " As you add costs, you're

> preventing someone else from affording coverage. "

> Autism, a neurological disorder that impedes social interaction and

> creative thought, has been a political issue throughout Doyle's

time

> as governor.

>

> In 2003, Doyle's administration said it would end Medicaid funding

> for autism treatment on the heels of a similar federal decision,

but

> then was able to secure permission from the federal government to

> continue state-supported autism treatment.

>

> Then in 2005, Doyle's proposed budget removed funding for the

> program, only to later agree to have $26.7 million put back in the

> budget under political pressure.

>

> Seventeen states mandate some kind of autism coverage, according to

> the National Association of Insurance Commissioners, Washington,

D.C.

> Now in Doyle's third budget preparations, he has promised full

> funding for state-sponsored coverage. But he will also demand that

> private insurance pay for those who don't qualify for a Medicaid

> waiver or are put on a waiting list.

>

> That's necessary because autism diagnoses in children attending

> Wisconsin public schools have increased from 400 in 1992 to 5,000

in

> 2005, said Nissan Bar-Lev, Wisconsin's special education

coordinator

> for the northeastern region and member of the Governor's Council on

> Autism.

>

> " Since the state has already invested probably more money than most

> into autism, (Doyle) is thinking, 'who else can help out?' and

> there's the private sector, " said Bar-Lev.

>

[Guest guest]

Rhonda,

Do you have the link address for this article. I could not find it

online.

Lenny

>

> Insurance industry opposes autism funding proposal

>

> The Business Journal of Milwaukee

> by Ben Fischer

>

> Gov. Jim Doyle's proposal to require insurance companies to cover at-

> home treatments for autism is drawing skepticism from health

> insurance companies.

>

> While details of Doyle's proposal were expected to be released March

> 16, the health insurance industry is already gearing up to oppose it,

> if only out of a philosophical objection to mandated coverage of any

> condition. The autism mandate is no different, said Phil Dougherty,

> lobbyist for the Wisconsin Association of Health Plans, Madison.

>

> " It's still an additional cost, and you're adding costs on top of an

> already unaffordable, or nearly unaffordable, program for a lot of

> small employers, " Dougherty said. " As you add costs, you're

> preventing someone else from affording coverage. "

> Autism, a neurological disorder that impedes social interaction and

> creative thought, has been a political issue throughout Doyle's time

> as governor.

>

> In 2003, Doyle's administration said it would end Medicaid funding

> for autism treatment on the heels of a similar federal decision, but

> then was able to secure permission from the federal government to

> continue state-supported autism treatment.

>

> Then in 2005, Doyle's proposed budget removed funding for the

> program, only to later agree to have $26.7 million put back in the

> budget under political pressure.

>

> Seventeen states mandate some kind of autism coverage, according to

> the National Association of Insurance Commissioners, Washington, D.C.

> Now in Doyle's third budget preparations, he has promised full

> funding for state-sponsored coverage. But he will also demand that

> private insurance pay for those who don't qualify for a Medicaid

> waiver or are put on a waiting list.

>

> That's necessary because autism diagnoses in children attending

> Wisconsin public schools have increased from 400 in 1992 to 5,000 in

> 2005, said Nissan Bar-Lev, Wisconsin's special education coordinator

> for the northeastern region and member of the Governor's Council on

> Autism.

>

> " Since the state has already invested probably more money than most

> into autism, (Doyle) is thinking, 'who else can help out?' and

> there's the private sector, " said Bar-Lev.

>

[Guest guest]

>

> Rhonda,

> Do you have the link address for this article. I could not find it

> online.

>

> Lenny

Hi Lenny,

Someone else just informed me also about posting the links. I had no

idea...so here it is, and any further citations will include the link:

http://milwaukee.bizjournals.com/milwaukee/stories/2007/03/19/story8.htm

l