The Centers for Disease Control and Prevention (CDC) estimates that on average, one in 110 U.S. children is diagnosed with an autism spectrum disorder (ASD), which can interfere with communication and social functioning. Various treatments for these conditions can be costly, yet as of June 2010, only about 22 states required health insurance companies to cover the costs for their customers. As the trend reverses, however, more insurers are being made to provide support.
History
In her book, "Thinking in Pictures," Dr. Temple Grandin writes that Leo Kanner first defined the symptoms of what is now known as classic autism in 1943. Many children diagnosed with the condition were institutionalized, but over the next six decades, diagnostic criteria and treatments underwent a massive shift. Today, the accepted wisdom is that with early and appropriate treatment, symptoms can improve and many individuals with autism can function within the community. However, therapy often is expensive.
Costs
The most common treatments for autism spectrum traits are behavioral, speech, occupational and physical therapies. The December 2004 "Monitor" article "Effective Education for Autism" points out that these often are intensive, one-to-one sessions with a professional therapist and can cost more than $40,000 a year. Some school districts will provide services for school-age children, but if not or for younger children, it may fall to the parent to find private treatment. These costs may be prohibitive, and more than a few families are forced to do without them.
Considerations
According to the CDC, “the lifetime cost to care for an individual with an ASD is $3.2 million,” with at least part of that coming from public sources if you can’t meet that financial responsibility on your own. James Mulick, Ph.D., of Ohio State University, cites a figure of $6 million in the "Monitor" article and points out the significant cost savings of treatment, noting that "If you spend $150,000 and they become capable of normal learning by third grade, that's a huge savings."
Obstacles to Obtaining Coverage
Health insurance companies typically have refused to cover autism treatments. One reason is that treatments have not been seen as medical but as educational responses to the condition, an idea that the American Academy of Pediatrics supported, according to the June 4, 2010, "Psychatric Times" article "Update on Coverage Mandates for Patients with Autism." It also is difficult to gauge the effectiveness of the treatments, and companies are reluctant to spend money on a maybe. Employers face higher premiums and don’t have much motivation to support initiatives mandating coverage.
Support and Solutions
Since 2008, it has become easier to obtain insurance coverage for autism treatments. The Autism Society of America's federal legislation pages report that the health care reform bill signed in March 2010 included a requirement for insurers to cover “behavioral health treatments.” The Autism Treatment Acceleration Act of 2009 includes diagnosis and a broad spectrum of treatments to be eligible for insurance coverage. As of June 2010, several more states were exploring legislation to support parents in managing their child’s treatment needs.
