It's time for Medical Insurance Companies in Oregon to cover Autism Treatment

Autism Health Insurance Reform: OPB Think Out Loud Tomorrow + Updates on City of Portland, Enforcement, and Legislation

Summary:

  • OPB’s Think Out Loud will talk about Insurance Coverage for Autism tomorrow 6/21/12
  • More press coverage in the Oregonian and the Lund Report
  • Continued Success with Appeals to Obtain Coverage for ABA
  • Progress on Autism Health Insurance Reform Legislation for 2013

OPB’s Think Out Loud will talk about Insurance Coverage for Autism tomorrow 6/21/12 at 9:40 AM

As I reported last month, the Portland City Council has voted to provide comprehensive coverage of autism therapies to its’ employees, beginning July 1st.

This plan – developed under the leadership of Commissioners Amanda Fritz and Dan Saltzman – will include coverage of Applied Behavior Analysis (ABA), without a fixed age or dollar cap, and will remove some of the existing limitations on coverage of speech, occupational, physical, and audiological therapy.

OPB’s guests will include Tobi Rates of the Autism Society, and Anastasia Puha, the mother of a child with autism covered under the city’s health benefit plan, who worked with me to persuade the City of Portland’s to adopt its’ new plan.

In addition to the city’s plan, the show will also discuss a recent decision by the Federal government to provide coverage of ABA for Federal employees and their dependents with autism, and our efforts to both improve and enforce Oregon’s laws requiring treatment of autism.

I encourage everyone to listen – and also to go to Think Out Loud’s website now to post supportive comments, and “Like” the program on Facebook. You can find it at:

http://www.opb.org/thinkoutloud/shows/insurance-coverege-for-autism/

More press coverage in the Oregonian, the Lund Report, and online:

There has been a lot of great coverage about our work on the Autism Health Insurance Reform issue in Oregon, both in the media and the web.  Here are some key articles you may be interested in:

In addition, here are two blog entries:

Continued Success with Appeals to Obtain Coverage for ABA

We are continuing to have success in helping families obtain coverage for ABA therapy under Oregon’s existing laws, using administrative appeals processes.  So far, every case we have taken through to “External Review” with an Independent Review Organization (IRO) appointed by the Insurance Division has been successful (we’ve won 9 out of 9 – with many more in process).  IRO decisions are binding in Oregon, so once we win one the insurer must comply or pay a fine of up to $1 million.

We have won cases with both Kaiser and Providence, on a range of plans from Individual to Group to government (OEBB and City of Portland so far – with PEBB and Multnomah County successes anticipated shortly!).  We are also starting other cases with Regence, Oregon Health Plan, OPM, and other insurers.

If you have any interest in Applied Behavior Analysis therapy, please contact me to talk about how to get started with your case.  If you post a comment to this page, I’ll follow-up with you offline (and won’t publish your comment if you are just trying to reach me for help).

Progress on Autism Health Insurance Reform Legislation for 2013

We continue to work on Autism Health Insurance Reform legislation for 2013, under the leadership of Senator Alan Bates and Senator Mark Hass.  We have held two meetings with the legislature and insurance industry in the capitol so far, and expect to meet again during the month of July to finalize an initial draft.

The insurance industry appears committed to passing Autism Health Insurance Reform – because they see that the writing is on the wall, and that new legislation is preferable to them than the avalanche of lawsuits that their compatriots are facing in Washington State.  Kaiser has even begun telling its’ members that they look forward to covering ABA – but only after the new law passes in 2014.  (We have no intention of allowing them to wait before complying with the laws that we already have).

I will provide more details about this work once they are available.

Thanks,

Paul Terdal

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