$3000 Monthly For Mandated Autism Treatment; Gee Thanks

| by Val

Holy buckets! I was surprised to learn what an autism insurance mandate might do for families of autism affected children. The families still get to pay every penny of the expense out of pocket, by paying a very high monthly premium.

A mother in Missouri says that the autism insurance coverage law (recently passed) in Missouri has been no gift for her family. Her story shows that the law was passed without any true insight to the overall issue of funding autism intervention therapies. Her insurance company told her, after the mandate was in place, that they would be glad to cover her child's treatment; for an added charge of 3000 dollars per month.

Oh the problem of the state by state autism insurance mandate. Can it be that, in Missouri and most probably in every other state in the US, the insurance companies may actually make lemonade? Not only can they explain any rate hikes away by representing that the mandated autism insurance coverage is the reason for their increase - they are also able to charge families of children with autism more premium dollars because of the already determinable costs of intensive autism therapies. There continues to be no free lunch (so to speak); an exception to the free lunch analogy being utilization of already mandated programs in public schools.

The mandate march will happen differently for every state. In October of 2010, comments on AboutAutism related how the governor of NY vetoed the Autism Speaks / S7000 Insurance Industry Bill (as referred to on aboutautism comments section) - what is generally not indicated in the reports of the veto is the fact that passage of another bill, A6888B seems to have been essentially derailed due to the fact that Autism Speaks put a lot muscle behind S7000.

There was controversy with regard to if the Autism Speaks / S7000 was best; or if A6888B should prevail. What would either bill have actually done for the families of autism affected children? It looks like the Autism Speaks preferred bill simply left coverage issues to peer review, while the A6888B attempted to get around the need for evidence based and clinical proven strategies for autism intervention.

S7000B/A10372A allows insurance companies to deny basic interventions such as speech therapy, physical therapy, occupational therapy, and ABA therapy on the ground that they are not "evidence based", "peer-reviewed" and "clinically proven." S7000B/A10372A opens up the insurance industry so that everything is fair game, and in the marketplace today the game has been played to deny or severely limit coverage. (link)

Assembly Bill A6888B... (prescriptively enumerates covered therapies) without limiting coverages that are not specifically identified in A6888B the language of the bill. Contrary to the claims of its critics, Assembly Bill A6888B specifically enumerates covered therapies "such as" speech, physical, occupational and ABA therapy, but allows for coverage of additional treatments that are medically necessary and not experimental. (link)

Is giving unfettered access (via bills like A6888B) to funding via health insurance - without the benefit of checks and balances on types and costs of therapies, and if they are proven - possible? Or, when every mandate is set into law and implemented - are families simply back where they started in the first place.

Intensive behavioral programs have been presented as something that is a specifically defined treatment, however they are not. There is no set program that has proven to give the kind of life-long benefit that many of the experts try to empirically imply - as they lobby your government officials and the media.  Some experts seem to go so far as to infer that with enough intensity of instruction, ABA type teaching programs will modify the neurology that is responsible for the presentation of autism - thereby eradicating it. That is theory. I can only guess that funding is assured for those who present chance and empirical truth.

Refer to this article when considering autism treatments that will supposedly be covered by insurance - through current mandates. According to Jean Mercer, Ph.D., complimentary and alternative treatments (CAM) are not considered medically approved. Basically, if there is not significant data to support the method, it does not become medically approved. CAMs are generally methods that have anecdotal findings that need to be pursued.

What is the anecdoctal ABA, and is it specific or enumerable?: There exists no set formula or program that churns out a set result when utilizing ABA. ABA is an applied science of human behavior that must be uniquely applied for each autism affected individual. There is no set - or uniformly agreed upon procedure, practice or curriculum that defines it. As far as applied science of human behavior (Applied Behavior Analysis) that informs affective autism treatment, there remains many questions with regard to which procedures, practices and curricula fall under the ABA umbrella. (see comments here)

Studies that have attempted to ascertain efficacy of various ABA type autism interventions (coined as ABA or behavioral type) might be called into question.  How many times have educational and psychological research endeavors into differing ABA types of programming been based upon the group research model? Group research models de-emphasize individual differences in autism affected children, making an assumption that - making a conclusion based upon an overall group response average provides a truthful or scientific result? It does not.

There are some who point out that a different model for autism intervention must be considered: ...Obviously you need a higher degree of training in order to apply individually tailored treatments to different children, and hence the traditional funding models don't easily accommodate the use of highly qualified Board Certified Behavior Analysts. But those are the very funding models that we need to advocate for. (Dr. Eric Larsen)

Two group studies come to mind...The earliest Lovaas' study into ABA type teaching has been questioned, and a most recent review of study done by Early Start Denver Model (ESDM) pointed out that ESDM's intervention did not eliminate signs of autism, and does not have the benefit of any long term follow up of the children studied. Notes by MJ Conner indicate that long term follow up was engaged upon for the Lovaa's group.

The Lovaas' study results are questioned because the term recovery was used to describe children whose measured ability fell into the average range (upon initiation of programming) and (also to those) who were being educated within mainstream schools. Children with higher functioning autism could well achieve such outcomes via other interventions, and (furthermore) a follow-up of some of the recovered children at age 13 revealed a continuation of significant behavioral issues. (M.J. Conner Notes)

For the Lovaas' study, the term recovery was used based on measures that hadn't really improved, and long term follow up indicated continued significant behavioral features of autism. James Copeland points out that Lovaas' results have not - to this day - been replicated.


Years ago, when I believed I might be able to normalize my daughter via earliest intervention strategies, the biggest and best thing I recieved from feeling she would be normalized - was a good night's sleep. However, there are professionals who experience a lot of prestige while making big money and running big programs and they may want to be right for all the wrong reasons. 

So evident today is the emergence of true dilemma that presents within any atmosphere where - if one might be able to get something personally gratuitous from a hypothesis which must become fact, they are compelled toward the data that falls in complete favor of the hypothesis; the probability factor for motivation, askew, increases. Perhaps the reality of such atmosphere is the biggest and best reason for opposing sides, or parties that do not always agree - for all of those who are looking into legal matters, medical matters, autism intervention matters, or anything that matters. Yes, debate is healthy.

For some who engage in societies most relevant quests for truth - but who also have realized a possibility to experience significant gain, if their truth can become the real truth - their quest may become one where their perspective that contains within itself more then a dash of probable gain causes blindness to certain elements of the interpretations that the scientific journey entails. The questor's behavior becomes that of one who might engage upon incomplete interpretations, of the data.