More Autism Coverage

[Guest guest]

As diagnoses of autism rise, a growing number of families are grappling with the

worry and expense of finding treatment and special education for children with

the complex developmental disorder. And many are pressing employers and

legislators for help.

An estimated one in 110 children is diagnosed with autism in the U.S., and its

prevalence is increasing for reasons that aren't well understood, according to

the U.S. Centers for Disease Control and Prevention. Average medical

expenditures for those with autism-spectrum disorders exceed those without by

$4,110 to $6,200 per year, the CDC states.

In response, at least 23 states, including Indiana, South Carolina, Arizona and

Massachusetts, have passed laws in the last few years requiring state-regulated

group health plans to include autism coverage, according to the National Council

of State Legislatures, though many states have caps on the mandates. Most other

states and Washington, D.C., have similar bills pending, according to Autism

Speaks, an advocacy group. Only Oklahoma, Utah and Wyoming don't have bills

requiring autism coverage on their agendas.

In addition, federal law now prohibits insurance companies from refusing to

issue or renew health-insurance coverage for children because of pre-existing

conditions, including autism.

The state laws don't apply to benefit plans employers fund themselves.

Self-funded plans are regulated by a federal statute, the Employee Retirement

Income Security Act of 1974, or ERISA. A growing number of self-funded

companies, however, are providing more health benefits for autism, often in

response to demands from employees or to harmonize with state laws, says Judith

Ursitti, regional director of state advocacy relations for Autism Speaks.

Microsoft offers comprehensive benefits for autism. And at least 20 other major

companies with self-funded plans say they provide at least some coverage for

treatment of autism -- most often speech and occupational therapy -- including

Home Depot, consultant Deloitte & Touche and drug maker Eli Lilly.

" They are seeing this is a more mainstream thing to do, a competitive benefit

that they need to provide for employees, " Ms. Ursitti says.

Terri Fields of Sunnyvale, Calif., says her husband's employer health plan is

helping to cover applied behavior analysis therapy, which many advocates and

medical groups regard as a standard treatment protocol, for their 7-year-old

son. He was diagnosed with autism when he was 18 months old. A previous employer

didn't cover it, and reimbursement for other therapies it did cover was

difficult to obtain, she says. Some insurers consider ABA experimental or not

medically necessary.

A sample therapy program of ABA can cost more than $60,000 per year, experts

say.

Today, Ms. Fields's son is " progressing nicely now that he is getting optimal

treatment, " and the family is saving thousands of dollars a year.

Ms. Fields, a 42-year-old high-tech operations manager for a networking company,

says the benefits from her husband's employer have made a huge difference. " It

is saving money, the time and the emotional energy. It is [like] night and day

and I can't put a dollar value on that. "

For more information on autism and treatment, go to the site of the Centers for

Disease Control and Prevention, cdc.gov, as well as autismspeaks.org.