Insurance and Autism: Not Just For ABA?

A few years ago we switched health insurance providers and I was certainly glad for the choice at Charlie's two doctor visits in one day last Friday. We used to have to pay out of pocket for Charlie's pediatric neurologist (worth it) and co-pays for office visits and medicine that seemed to swallow up "yuppie coupons," especially during one of those winters when every cold that came to town took up residence in our living room.

When Charlie was much younger and doing many hours of ABA therapy at home, our then-ABA consultant noted that one way we could pay for the program (there's a whole business of ABA providers----another post) was by appealing to our insurance company. To our question of what to do if the claims were rejected, and of having to wait while that whole process went through, the consultant noted, yes, that could happen. And Jim and I, like so many parents of children newly diagnosed with autism, did not want to wait. Family helped out and Jim had a sabbatical from his job and a research grant. And, as most of the therapists were college students new to ABA, what we paid them was not the $65+/hour that therapists these days receive.

We knew families who had gone through rounds of appeals with their insurance companies to get ABA (and various other "therapies" for autism) covered. Doctors' visits and medicine have been all we've turned to insurance for. Charlie himself---though with the occasional bug and two trips to ER when he fell off his bike (no stitches, phrew ---is generally healthy.

Throughout last year, it seemed that every time there was mention of legislation about autism, what was usually meant was insurance for "autism treatment," with that "treatment" most often (if not always) a codeword for ABA. (You can access this database to get an overview of what states have passed, or have introduced, or are seeking to introduce, such legislation.) Arguments often used to call for insurance to cover ABA include the "crucial" need for ABA therapy starting when a child is very young, and also (as noted in a recent article in Business Insurance) because, it's suggested, that paying for costly ABA therapy now will lower the "cost to society" of caring for autistic adults still in need of services.

While objecting to the (dangerous) notion of an adult with disabilities as some kind of "burden" to society, I understand these arguments. But I wonder if it's not time----or, rather, that it is simply time now----to broaden and shift the discussion about autism and insurance, to be more about different therapies and age groups and less about getting in so many hours of therapy for a young child. This discussion can and needs to include more of an understanding of the potentially long-term needs of a person with disabilities who, with the right supports and enough of them, can do very, very well.

Image of caduceus by takomabibelot.